Systems and Devices for Cutting Tissue

ABSTRACT

Systems and devices are described which include a tissue cutting device including a tethering component; an elongated flexible cutting component having a first end and a second end, the first and the second end of the elongated flexible cutting component secured to the tethering component; at least one tether having a first end and a second end, the first end of the at least one tether attached to the elongated flexible cutting component, the second end of the at least one tether operably coupled to the tethering component, the tethering component configured to at least one of extend and retract the at least one tether; and a motor operably coupled to the tethering component, the motor including circuitry configured to rotate the tethering component and the secured elongated flexible cutting component; wherein extension and retraction of the at least one tether by the tethering component changes a shape formed by the elongated flexible cutting component.

If an Application Data Sheet (ADS) has been filed on the filing date ofthis application, it is incorporated by reference herein. Anyapplications claimed on the ADS for priority under 35 U.S.C. §§119, 120,121, or 365(c), and any and all parent, grandparent, great-grandparent,etc. applications of such applications, are also incorporated byreference, including any priority claims made in those applications andany material incorporated by reference, to the extent such subjectmatter is not inconsistent herewith.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit of the earliest availableeffective filing date(s) from the following listed application(s) (the“Priority Applications”), if any, listed below (e.g., claims earliestavailable priority dates for other than provisional patent applicationsor claims benefits under 35 USC §119(e) for provisional patentapplications, for any and all parent, grandparent, great-grandparent,etc. applications of the Priority Application(s)).

PRIORITY APPLICATIONS

None

If the listings of applications provided above are inconsistent with thelistings provided via an ADS, it is the intent of the Applicant to claimpriority to each application that appears in the DomesticBenefit/National Stage Information section of the ADS and to eachapplication that appears in the Priority Applications section of thisapplication.

All subject matter of the Priority Applications and of any and allapplications related to the Priority Applications by priority claims(directly or indirectly), including any priority claims made and subjectmatter incorporated by reference therein as of the filing date of theinstant application, is incorporated herein by reference to the extentsuch subject matter is not inconsistent herewith.

SUMMARY

In an aspect, a tissue cutting device includes, but is not limited to, acentral rotatable shaft having a first end and a second end; a motoroperably coupled to the first end of the central rotatable shaft, themotor including circuitry configured to rotate the central rotatableshaft; a moveable component configured to move along at least a portionof the length of the central rotatable shaft; and an elongated flexiblecutting component having a first end and a second end, the first end ofthe elongated flexible cutting component secured to the moveablecomponent and the second end of the elongated flexible cutting componentsecured to the central rotatable shaft in proximity to the second end ofthe central rotatable shaft; wherein movement of the moveable componentalong the at least a portion of the length of the central rotatableshaft changes a shape formed by the elongated flexible cuttingcomponent. In addition to the foregoing, other device aspects aredescribed in the claims, drawings, and text forming a part of thepresent disclosure.

In an aspect, a tissue cutting system includes, but is not limited to, atissue cutting device including a central rotatable shaft having a firstend and a second end; a motor operably coupled to the first end of thecentral rotatable shaft, the motor including circuitry configured torotate the central rotatable shaft; a moveable component configured tomove along at least a portion of the length of the central rotatableshaft; and an elongated flexible cutting component having a first endand a second end, the first end of the elongated flexible cuttingcomponent secured to the moveable component and the second end of theelongated flexible cutting component secured to the central rotatableshaft in proximity to the second end of the central rotatable shaft;wherein movement of the moveable component along the at least a portionof the length of the central rotatable shaft changes a shape formed bythe elongated flexible cutting component; and a computing componentoperably connected to the tissue cutting device, the computing componentincluding a processor and circuitry. In addition to the foregoing, othersystem aspects are described in the claims, drawings, and text forming apart of the present disclosure.

In an aspect, a tissue cutting device includes, but is not limited to, atethering component; an elongated flexible cutting component having afirst end and a second end, the first and the second end of theelongated flexible cutting component secured to the tethering component;at least one tether having a first end and a second end, the first endof the at least one tether attached to the elongated flexible cuttingcomponent at a position between the first and the second end of theelongated flexible cutting component, the second end of the at least onetether operably coupled to the tethering component, the tetheringcomponent configured to at least one of extend and retract the at leastone tether; and a motor operably coupled to the tethering component, themotor including circuitry configured to rotate the tethering componentand the secured elongated flexible cutting component; wherein extensionand refraction of the at least one tether by the tethering componentchanges a shape formed by the elongated flexible cutting component. Inaddition to the foregoing, other device aspect are described in theclaims, drawings, and text forming a part of the present disclosure.

In an aspect, a tissue cutting system includes, but is not limited to, atissue cutting device including a tethering component, an elongatedflexible cutting component having a first end and a second end, thefirst end and the second end of the elongated flexible cutting componentsecured to the tethering component, at least one tether having a firstend and a second end, the first end of the at least one tether attachedto the elongated flexible cutting component at a position between thefirst end and the second end of the elongated flexible cuttingcomponent, the second end of the at least one tether operably coupled tothe tethering component, the tethering component configured to at leastone of extend and retract the at least one tether, and a motor operablycoupled to the tethering component, the motor including circuitryconfigured to rotate the tethering component and the secured elongatedflexible cutting component; and a computing component operably coupledto the tissue cutting device, the computing component including aprocessor and circuitry. In addition to the foregoing, other systemaspects are described in the claims, drawings, and text forming a partof the present disclosure.

In an aspect, a tissue cutting device includes, but is not limited to, acentral rotatable shaft having a first end and a second end; a motoroperably coupled to the first end of the central rotatable shaft, themotor including circuitry configured to rotate the central rotatableshaft; a tethering component; and an elongated flexible cuttingcomponent having a first end and a second end, the first end of theelongated flexible cutting component secured to the central rotatableshaft at a position between the first end and the second end of thecentral rotatable shaft, the second end of the elongated flexiblecutting component operably coupled to the tethering component, thetethering component configured to at least one of extend and retract theelongated flexible cutting component; wherein extension and retractionof the elongated flexible cutting component by the tethering componentchanges a shape formed by the elongated flexible cutting component. Inaddition to the foregoing, other device aspects are described in theclaims, drawings, and text forming a part of the present disclosure.

In an aspect, a tissue cutting system includes, but is not limited to atissue cutting device including a central rotatable shaft having a firstend and a second end, a motor operably coupled to the first end of thecentral rotatable shaft, the motor including circuitry configured torotate the central rotatable shaft, a tethering component, and anelongated flexible cutting component having a first end and a secondend, the first end of the elongated flexible cutting component securedto the central rotatable shaft at a position between the first and thesecond end of the central rotatable shaft, the second end of theelongated flexible cutting component operably coupled to the tetheringcomponent, the tethering component configured to at least one of extendand retract the elongated flexible cutting component; and a computingcomponent operably connected to the tissue cutting device, the computingcomponent including a processor and circuitry. In addition to theforegoing, other system aspects are described in the claims, drawings,and text forming a part of the present disclosure.

The foregoing summary is illustrative only and is not intended to be inany way limiting. In addition to the illustrative aspects, embodiments,and features described above, further aspects, embodiments, and featureswill become apparent by reference to the drawings and the followingdetailed description.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a schematic of tissue cutting device.

FIG. 2A is a schematic of a tissue cutting device at a first position ina tissue.

FIG. 2B is a schematic of a tissue cutting device at a second positionin a tissue.

FIG. 3A is a schematic of a shape formed by a rotating elongatedflexible cutting component.

FIG. 3B is a schematic of a shape formed by a rotating elongatedflexible cutting component.

FIG. 4A is a schematic of a tissue cutting device including a moveablecomponent associated with a central rotatable shaft.

FIG. 4B is a schematic of a cross-section through a moveable componentassociated with a central rotatable shaft.

FIG. 4C is a schematic of a cross-section through a moveable componentassociated with a central rotatable shaft.

FIG. 5A is a schematic of a tissue cutting device including a moveablecomponent associated with a central rotatable shaft.

FIG. 5B is a schematic of a cross-section through a moveable componentassociated with a central rotatable shaft.

FIG. 5C is a schematic of a cross-section through a moveable componentassociated with a central rotatable shaft.

FIG. 6 is a schematic of a tissue cutting device including an aspirationcomponent.

FIG. 7 is a schematic of a tissue cutting device including an aspirationcomponent.

FIG. 8 is a schematic of a tissue cutting device including an aspirationcomponent.

FIG. 9 illustrates further aspects of a tissue cutting device.

FIG. 10A illustrates aspects of a torque compensation component.

FIG. 10B illustrates aspects of a torque compensation component.

FIG. 10C illustrates aspects of a torque compensation component.

FIG. 11A illustrates aspects of a torque compensation component.

FIG. 11B illustrates aspects of a torque compensation component.

FIG. 11C illustrates aspects of a torque compensation component.

FIG. 12A illustrates aspects of a drag compensation component.

FIG. 12B illustrates aspects of a drag compensation component.

FIG. 13A illustrates aspects of a drag compensation component.

FIG. 13B illustrates aspects of a drag compensation component.

FIG. 13C illustrates aspects of a drag compensation component.

FIG. 14 is a schematic of a tissue cutting system.

FIG. 15 illustrates further aspects of a tissue cutting system.

FIG. 16 is a schematic of a tissue cutting device including at least onetether.

FIG. 17A is a schematic of a tissue cutting device including at leastone tether at a first position in a tissue.

FIG. 17B is a schematic of a tissue cutting device including at leastone tether at a second position in a tissue.

FIG. 18A is a schematic of a tissue cutting device including twotethers.

FIG. 18B is a schematic of a tissue cutting device including two tetherswith an elongated flexible cutting component forming a first shape.

FIG. 18C is a schematic of a tissue cutting device including two tetherswith an elongated flexible cutting component forming a second shape.

FIG. 19 illustrates further aspects of a tissue cutting device includingat least one tether.

FIG. 20 illustrates further aspects of a tissue cutting device includingat least one tether.

FIG. 21 is a schematic of a tissue cutting system.

FIG. 22 illustrates further aspects of a tissue cutting system.

FIG. 23 is a schematic of a tissue cutting device.

FIG. 24 is a schematic of a tissue cutting device.

FIG. 25A is a schematic of a tissue cutting device at a first positionin a tissue.

FIG. 25B is a schematic of a tissue cutting device at a second positionin a tissue.

FIG. 26 is a schematic of a tissue cutting device including anaspiration component.

FIG. 27 is a schematic of a tissue cutting device including anaspiration component.

FIG. 28 is a schematic of a tissue cutting device including anaspiration component.

FIG. 29 illustrates further aspects of a tissue cutting device.

FIG. 30 is a schematic of a tissue cutting system.

FIG. 31 illustrates further aspects of a tissue cutting system.

DETAILED DESCRIPTION

In the following detailed description, reference is made to theaccompanying drawings, which form a part hereof. In the drawings,similar symbols typically identify similar components, unless contextdictates otherwise. The illustrative embodiments described in thedetailed description, drawings, and claims are not meant to be limiting.Other embodiments may be utilized, and other changes may be made,without departing from the spirit or scope of the subject matterpresented here.

FIG. 1 illustrates aspects of a tissue cutting device. Tissue cuttingdevice 100 includes central rotatable shaft 110 having a first end 112and a second end 114. Tissue cutting device 100 further includes motor120 operably coupled to the first end 112 of central rotatable shaft110, the motor 120 including circuitry configured to rotate the centralrotatable shaft 110. Tissue cutting device 100 further includes moveablecomponent 130 configured to move along at least a portion of the lengthof the central rotatable shaft 110. Tissue cutting device 100 furtherincludes an elongated flexible cutting component 140 having a first end142 and a second end 144, the first end 142 of the elongated flexiblecutting component 140 secured to the moveable component 130 and thesecond end of the elongated flexible cutting component secured to thecentral rotatable shaft 110 in proximity to the second end 114 of thecentral rotatable shaft 110. The movement of the moveable component 130along the at least a portion of the length of the central rotatableshaft 110 changes a shape formed by the elongated flexible cuttingcomponent 110.

In an aspect, the elongated flexible cutting component 110 forms aD-shape when attached at the first end to the moveable component and atthe second end to the central rotatable shaft in proximity to the secondend of the central rotatable shaft. In an aspect, movement of themoveable component along the at least a portion of the length of thecentral rotatable shaft changes aspects of the D-shape formed by theelongated flexible cutting component. For example, the D-shape can belengthened and flattened as the first end of the elongated flexiblecutting component attached to the moveable component moves away from thesecond end of the elongated flexible cutting component attached to thecentral rotatable shaft. For example, the D-shape can be shortened andwidened as the first end of the elongated flexible cutting componentattached to the moveable component moves towards the second end of theelongated flexible cutting component attached to the central rotatableshaft.

In an aspect, the shape formed by the elongated flexible cuttingcomponent is fixed. For example, the moveable component can bepositioned and locked into place prior to a cutting procedure, theradius of the shape formed by the elongated flexible cutting component,e.g., a D-shape, remaining constant and creating a symmetrical cuttingpattern upon rotation of the central rotatable shaft and the attachedelongated flexible cutting component.

In an aspect, the shape formed by the elongated flexible cuttingcomponent varies through the course of a cutting procedure. For example,the radius of the rotating elongated flexible cutting component can varyas the tissue cutting device is moved into the tissue, with a smallcutting radius at the point of entering the tissue and a larger cuttingradius once the target tissue for resection has been reached.

FIGS. 2A and 2B illustrate changes in the shape formed by the elongatedflexible cutting component as well as the tissue cutting pattern inresponse to moving the moveable component along the at least a portionof the length of the central rotatable shaft to change the shape formedby the elongated flexible cutting component. FIG. 2A shows tissuecutting device 100 at a first time point relative to tissue 200. Tissuecutting device 100 includes central rotatable shaft 110, motor 120,moveable component 130, and elongated flexible cutting component 140.Tissue cutting device 100 is shown cutting into tissue 200 and targettissue mass 210. Moveable component 130 and elongated flexible cuttingcomponent 140 are in a first position that creates resected space 220 ascentral rotatable shaft 130 and attached elongated flexible cuttingcomponent 140 are rotated by motor 120. As the elongated flexiblecutting component 140 rotates, it cuts away at tissue 200 in a patterndependent upon the shape formed by the elongated flexible cuttingcomponent 140. FIG. 2B shows tissue cutting device 100 at a second timepoint relative to tissue 200. At this point, central rotatable shaft 110is shown further into tissue 200. Moveable component 130 and elongatedflexible cutting component 140 are in a second position that createsresected space 230 as central rotatable shaft 110 and attached elongatedflexible cutting component 140 are rotated by motor 120. In thisexample, tissue mass 210 has been removed, leaving resected space 230.

In an aspect, a tissue cutting device such as described herein is usedfor minimally invasive surgery to cut and resect tissue. In an aspect,the tissue cutting device is inserted into a tissue of a patient. Insome embodiments, the distal portion of the tissue cutting device (e.g.,the second end of the central rotatable shaft) is adapted to piercetissue. In other embodiments, the tissue cutting device is inserted intoa previously established surgical incision (e.g., a 0.5 cm to 2 cmincision). In an aspect, the tissue cutting device is inserted into abody lumen (e.g., a blood vessel, gastrointestinal tract, vagina,rectum, airway, ureter, or urethra).

A tissue cutting device such as described herein can enter tissue by anyof a number of routes including, but not limited to, transabdominal,transperineal, transcutaneous, transvascular, transurethral,transureteral, transoral, transvaginal, and transrectal routes ofinsertion. A wide range of tissue can be cut and resected including butnot limited to prostatic tissue, kidney tissue, liver tissue, uterinetissue, bladder tissue, and brain tissue. In an aspect, the tissue to becut and resected is benign tissue (e.g., fibrotic tissue in uterus orprostate). In an aspect, the tissue to be cut and resected is malignanttissue (e.g., a solid tumor).

In an aspect, the tissue cutting device is sized for placement intocannula or trocar. For example, the central rotatable shaft, moveablecomponent, and elongated flexible cutting component of the tissuecutting device may be extended from or retracted into a cannula ortrocar configured for performing minimally invasive surgery.

In an aspect, the tissue cutting device includes a hand-held deviceconfigured for use by a surgeon or other medical practitioner. In anaspect, the tissue cutting device is included in a robotic surgeryapparatus. For example, the tissue cutting device can be included in acomputer-assisted surgery apparatus, a robotically-assisted surgeryapparatus, an unmanned surgery apparatus, and the like. For example, thetissue cutting device can be included in a steerable catheter system.For example, the tissue cutting device can be included in a daVinci®type of robotic system (from, Intuitive Surgical, Inc., Sunnyvale,Calif.).

In an aspect, the shape formed by the elongated flexible cuttingcomponent is varied during the course of a single rotation. For example,the characteristics of the D-shape formed by the elongated flexiblecutting component can be varied during the course of a single rotationby coordinating the movement of the moveable component with therotational movement of the central rotatable shaft. In an aspect,varying the shape formed by the elongated flexible cutting componentduring the course of a single rotation results in an asymmetricalcutting pattern.

FIGS. 3A and 3B illustrate aspects of a single rotation of a centralrotatable shaft as the moveable component and attached elongatedflexible cutting component are moved along the length of the centralrotatable shaft. FIG. 3A illustrates a 180 degree rotation of centralrotatable shaft 110. Elongated flexible cutting component at 0 degrees(300) is shown rotating in a counter-clockwise manner into the plane ofthe page. Shown is the elongated flexible cutting component at 30degrees (305), the elongated flexible cutting component at 60 degrees(310), the elongated flexible cutting component at 120 degrees (320),the elongated flexible cutting component at 150 degrees (325), and theelongated flexible cutting component at 180 degrees (330). As theelongated flexible cutting component rotates through the various degreesof the rotation, the shape formed by the elongated flexible cuttingcomponent changes, i.e., becomes shorter and wider, in response tomovement of the moveable component 130 along the central rotatable shaft110 towards the second end of the elongated flexible cutting component.FIG. 3B illustrates another 180 degrees of rotation of central rotatableshaft 110 to complete a full rotation. The elongated flexible cuttingcomponent at 180 degrees (330) is shown rotating out of the plane of thepage. Shown is the elongated flexible cutting component at 210 degrees(335), the elongated flexible cutting component 240 degrees (340), theelongated flexible cutting component 300 degrees (345), the elongatedflexible cutting component at 330 degrees (350), and the elongatedflexible cutting component at 360 degrees (300). As the elongatedflexible cutting component rotates through the various degrees of therotation, the shape formed by the elongated flexible cutting componentchanges, i.e., becomes longer and narrower, in response to movement ofthe moveable component 130 along the central rotatable shaft 110 awayfrom the second end of the elongated flexible cutting component. Duringthe course of a 360 rotation, the shape formed by the elongated flexiblecutting component changes, creating an asymmetrical cutting pattern.

Motor

A tissue cutting device such as described herein includes a motor. In anaspect, the motor is operably coupled to the first end of the centralrotatable shaft and includes circuitry configured to rotate the centralrotatable shaft. In an aspect, the motor is an electric motor. In anaspect, the motor has a single rotational frequency. In an aspect, themotor includes a simple on/off switch and a single rotational frequency.For example, the motor can include an on/off switch which when turned onrotates the central rotatable shaft at a fixed rotational frequency. Inan aspect, the motor includes variable rotational frequency. In anaspect, the motor includes circuitry configured to control therotational frequency of the motor. For example, the motor can include auser interface (e.g., a dial or buttons) to allow a user to increase ordecrease the rotational frequency. In an aspect, the motor is operablycoupled to a computing component, the computing component includingcircuitry to control the rotational frequency of the motor.

In an aspect, the motor is a rotary shaft motor, such as a conventionalDC, pulse, or AC motor. In an aspect, the motor can include a brush DCmotor. In an aspect, the motor can include a DC servo. In an aspect, themotor can include a rotary piezoelectric motor. Other non-limitingexamples of motors for use in rotating the central rotatable shaftinclude a stepper control motor, a brushless DC commutated controlmotor, or a universal motor. In general, motors for use in smallelectronics or hand-held devices are known in the art and available fromcommercial sources.

Moveable Component

In some embodiments, a tissue cutting device includes a moveablecomponent configured to move along at least a portion of the length ofthe central rotatable shaft. In an aspect, the moveable component isassociated with a groove running along at least a portion of the lengthof the central rotatable shaft. For example, the central rotatable shaft(e.g., a stainless steel rod) can include a groove into which at least aportion of the moveable component is positioned, the moveable componentable to move freely along the length of the groove. In an aspect, themoveable component is locked into the groove. For example, the moveablecomponent can include a shape or an additional fitting that locks themoveable component into the groove.

FIGS. 4A-4C illustrate aspects of a central rotating shaft including agroove. FIG. 4A shows a lower portion of tissue cutting device 400 witha groove. Tissue cutting device 400 includes central rotatable shaft 410operably connected to motor 420. Tissue cutting device 400 furtherincludes moveable component 430 configured to move along at least aportion of the length of central rotatable shaft 410. In this example,moveable component 430 is associated with groove 450 that runs along atleast a portion of the length of central rotatable shaft 410. Tissuecutting device 400 further includes elongated flexible cutting component440 secured at a first end to moveable component 430 and at a second endto central rotatable shaft 410. FIG. 4B illustrates a cross-section(dashed line 460 of FIG. 4A) through an embodiment of tissue cuttingdevice 400. In this example, a cross-section of tissue cutting device400 a includes central rotatable shaft 410 a including groove 450 a intowhich an appropriately shaped moveable component 430 a is inserted. Alsoshown is at least a portion of elongated flexible cutting component 440attached to moveable component 430 a. In some embodiments, the moveablecomponent can include a shape, e.g., an extension or flare, that allowsit to stay attached to but move freely along a groove associated withthe central rotatable shaft. FIG. 4C illustrates a cross-section (dashedline 460 of FIG. 4A) through another embodiment of tissue cutting device400. In this example, a cross-section of tissue cutting device 400 bincludes central rotatable shaft 410 b including groove 450 b into whichan appropriate shaped moveable component 430 b is inserted. Moveablecomponent 430 b includes an extension or flare 435 that fits into anappropriately shaped portion of groove 450 b. Also shown is at least aportion of elongated flexible cutting component 440 attached to moveablecomponent 430 b.

In an aspect, the moveable component is associated with a track runningalong at least a portion of the length of the central rotatable shaft.For example, the moveable component can be associated with a rod thatruns parallel to at least a portion of the length of the centralrotatable shaft. FIGS. 5A-5C illustrate aspects of a tissue cuttingdevice including a track. FIG. 5A shows a tissue cutting device 500 witha track. Tissue cutting device 500 includes central rotatable shaft 510operably connected to motor 520. Tissue cutting device 500 furtherincludes moveable component 530 configured to move along at least aportion of the length of central rotatable shaft 510. In this example,moveable component 530 is associated with track 550 that runs along atleast a portion of the length of central rotatable shaft 510. Tissuecutting device 500 further includes elongated flexible cutting component540 secured at a first end to moveable component 530 and at a second endto central rotatable shaft 510. FIG. 5B illustrates a cross-section(dashed line 560 of FIG. 5A) through an embodiment of tissue cuttingdevice 500. In this example, a cross-section of tissue cutting device500 a includes central rotatable shaft 510 including track 550. Moveablecomponent 530 a is appropriately shaped to associate with track 550. Inthis non-limiting example, moveable component 530 a defines an opening535 disposed over tract 550. Also shown is at least a portion ofelongated flexible cutting component 540 attached to moveable component530 a.

In an aspect, the moveable component includes a fitting that allows itto stay attached to but move freely along a track associated with thecentral rotatable shaft. A non-limiting example of a moveable componentincluding a fitting is shown in FIG. 5C. FIG. 5C illustrates across-section (560 of FIG. 5A) through an embodiment of tissue cuttingdevice 500. In this example, a cross-section of tissue cutting device500 b includes central rotatable shaft 510 including track 550. In thisnon-limiting example, moveable component 530 b includes fitting 570 thatfits around track 550, keeping moveable component 530 b attached butfreely moveable. For example, fitting 570 can include a ring that isattached to the moveable component and configured to encircle the track,e.g., a rod. Also shown is at least a portion of elongated flexiblecutting component 540 attached to moveable component 530 a.

In an aspect, the moveable component is associated with or includes arotatable belt, the length of which extends along at least a portion ofthe length of the central rotatable shaft. In an aspect, the moveablecomponent is moved along the track by a chain, belt, or screw that turnswhen an operably coupled second motor is operated.

In an aspect, the moveable component is attached to a tetheringcomponent, the tethering component configured to move the moveablecomponent along the length of the central rotatable shaft. In an aspect,the tethering component is configured to pull the moveable componentalong at least a portion of the length of the central rotatable shaft tochange the shape formed by the elongated flexible cutting component. Forexample, the tethering component can include a flexible member (e.g., awire or string) that pulls the moveable component. In an aspect, thetethering component is configured to push the moveable component alongat least a portion of the length of the central rotatable shaft tochange the shape formed by the elongated flexible cutting component. Forexample, the tethering component can include a rigid member (e.g., arod) that pushes the moveable component.

In an aspect, the tethering component includes a tether attached to themoveable component, the tethering component configured to extend andretract the tether. In an aspect, retracting the tether uses a rotatingelement to wind up the tether. In an aspect, the tethering componentuses a braking system to control extension and retraction of the tether.For example, the tether can be extended by releasing a brake, allowingthe tether to feed out under the centrifugal force generated as thecentral rotatable shaft spins. The amount of tether fed out can becontrolled by stopping/starting the braking system.

In an aspect, the moveable component is attached to a rod that moves upand down, pushing and/or pulling the moveable component along the lengthof the central rotatable shaft. For example, a small rotary motor can beused to move the rod up and down, pushing and/or pulling the moveablecomponent and thereby changing the shape formed by the elongatedflexible cutting component.

Elongated Flexible Cutting Component

A tissue cutting device includes an elongated flexible cuttingcomponent. In an aspect, the elongated flexible cutting component isattached at a first end to a moveable component. In an aspect, movementof the moveable component along at least a portion of the centralrotatable shaft changes a shape formed by the elongated flexible cuttingcomponent. For example, the elongated flexible cutting component forms aD-shape that transforms in length and width as the moveable componentmoves along the length of the central rotatable shaft. In an aspect, theelongated flexible cutting component is at least one of a flexible wire,strand, string, fiber, thread, or ribbon.

In an aspect, the elongated flexible cutting component includes aflexible wire. In an aspect, the flexible wire includes a solid wire. Inan aspect, the flexible wire includes a stranded wire. In an aspect, theflexible wire includes a braided wire. In an aspect, the flexible wirehas a specific gauge or cross-sectional area. For example, the gauge ofthe flexible wire can be from about 2 millimeters to about 0.05millimeters. For example, the gauge of the flexible wire can be about 2millimeters, 1.8 millimeters, 1.6 millimeters, 1.4 millimeters, 1.2millimeters, 1.1 millimeters, 1.0 millimeters, 0.9 millimeters, 0.8millimeters, 0.7 millimeters, 0.6 millimeters, 0.5 millimeters, 0.45millimeters, 0.4 millimeters, 0.36 millimeters, 0.32 millimeters, 0.3millimeters, 0.25 millimeters, 0.23 millimeters, 0.2 millimeters, 0.18millimeters, 0.16 millimeters, 0.14 millimeters, 0.12 millimeters, 0.11millimeters, 0.1 millimeters, 0.09 millimeters, 0.08 millimeters, 0.07millimeters, 0.06 millimeters, or 0.05 millimeters.

In an aspect, the elongated flexible cutting component is formed frommetal. Non-limiting examples of metals suitable for forming an elongatedflexible cutting component include platinum, silver, iron, copper,aluminum, and gold. In an aspect, the elongated flexible cuttingcomponent is formed from a metal alloy, e.g., stainless steel, othersteel, titanium-nickel alloy, titanium-aluminum alloy, or other alloy ofhigh resiliency. In an aspect, the elongated flexible cutting componentis formed by drawing a metal, e.g., a metal alloy, through a hole in adie or draw-plate. In an aspect, the elongated flexible cuttingcomponent is formed by drawing a material, e.g., metal or polymer,through a draw-plate with a cylindrical hole. In an aspect, theelongated flexible cutting component is formed by drawing a material,e.g., metal or polymer, through a draw-plate with a non-cylindricalform, e.g., a triangle, square, pentagon, hexagon, or other multisidedpolygon.

In an aspect, the elongated flexible cutting component is formed from atleast one of natural fiber and man-made fiber. In an aspect, theelongated flexible cutting component is formed from natural fiber. Forexample, the elongated flexible cutting component can be formed fromvegetable fiber, e.g., cotton, hemp, jute, flax, ramie, sisal, orbagasse. For example, the elongated flexible cutting component can beformed from wood fiber. For example, the elongated flexible cuttingcomponent can be formed from animal fibers, e.g., silkworm silk, spidersilk, sinew, catgut, wool, sea silk, or hair. For example, the elongatedflexible cutting component can be formed from mineral fibers, e.g.,asbestos. In an aspect, the elongated flexible cutting component isformed from man-made fiber. For example, the elongated flexible cuttingcomponent can be formed from regenerated fibers, e.g., cellulose fromwood pulp. For example, the elongated flexible cutting component can beformed from semi-synthetic fibers, e.g., nylon (polyamide), Dacron(polyester), and rayon. For example, the elongated flexible cuttingcomponent can be formed from synthetic fibers, e.g., metallic fibers,carbon fiber, boron fiber, silicon carbide fiber, fiberglass, mineralfibers, polymer fibers, and microfibers. In an aspect, the elongatedflexible cutting component is formed from polymer fibers, non-limitingexamples of which include polyamide nylon, PET or PBT polyester,phenol-formaldehyde, polyvinyl chloride fiber, polyolefin fibers,acrylic polyesters, aromatic polyamids, polyethylene, elastomers,polyurethane fiber, elastolefin.

In an aspect, the elongated flexible cutting component includes amonofilament line. In an aspect, the elongated flexible cuttingcomponent is formed by extruding one or more types of polymer fibersthrough a hole defined by a die or draw-plate. In an aspect, theelongated flexible cutting component includes a multifilament line,e.g., a braided line. In an aspect, the elongated flexible cuttingcomponent is formed from a synthetic polymer, e.g., polyethylene, byextrusion that uses a multi-pored spinneret. For example, the elongatedflexible cutting component can be formed from a polymer using wet, dry,dry jet-wet, melt, gel, or electrospinning. In an aspect, the elongatedflexible cutting component is formed using a gel spinning or polymerspinning process.

In an aspect, the elongated flexible cutting component includes acircular cross-section. For example, the elongated flexible cuttingcomponent can be formed by extruding a metal or polymer through adraw-plate with an appropriately sized circular hole. In an aspect, theelongated flexible cutting component includes a non-circularcross-section. In an aspect, the elongated flexible cutting componentincludes a polygon cross-section including three or more sides. Forexample, the elongated flexible cutting component can be formed byextruding a metal or polymer through a draw-plate with an appropriatelysized polygon cross-section.

In an aspect, the elongated flexible cutting component includes at leastone cutting edge. For example, the elongated flexible cutting componentcan include a ribbon with a cutting edge. For example, the elongatedflexible cutting component can include a cross-sectional area, e.g., atriangular wedge, which includes a sharp edge.

In an aspect, the elongated flexible cutting component includes at leastone serrated edge. For example, at least one edge of the elongatedflexible cutting component can include a saw tooth design. For example,the elongated flexible cutting component can include a gigli saw wire.For example, the elongated flexible cutting component can be formed fromtwo or more metal wires braided together to generate a serrated edge.For example, the elongated flexible cutting component can include hooks,barbs, graters, or raised bumps.

In an aspect, the elongated flexible cutting component includes at leastone abrasive surface. For example, the elongated flexible cuttingcomponent can include diamond dust. For example, the elongated flexiblecutting component can include at least one of silica, sand, or glass. Inan aspect, the elongated flexible cutting component is treated in such away as to have an abrasive surface, such as by sand blasting. See, e.g.,U.S. Pat. No. 8,062,300 to Schmitz et al. titled “Tissue removal with atleast partially flexible device,” which is incorporated herein byreference.

In an aspect, the tissue cutting device includes two or more elongatedflexible cutting components. In an aspect, the first ends of the two ormore elongated flexible cutting components are secured to the moveablecomponent and the second ends of the two or more elongated flexiblecutting components are secure to the central rotatable shaft. In anaspect, the tissue cutting device may include a moveable component foreach of the two or more elongated flexible cutting components.

In an aspect, the elongated flexible cutting component is replaceable.For example, the elongated flexible cutting component may be secured tothe moveable component and/or the central rotatable shaft with areversible attachment component, e.g., a screw, a clamp, a crimp, or thelike. In an aspect, the elongated flexible cutting component is suppliedas a single unit. For example, the elongated flexible cutting componentmay be supplied as single strands or ribbons, the first end of which isconfigured to attach to a moveable component and the second end of whichis configured to attach to the central rotatable shaft. In an aspect,the elongated flexible cutting component is supplied as a multiunitsupply. For example, the multiunit supply may include a length ofelongated flexible cutting component that can be cut/reattached toreplace used, contaminated, and/or broken elongated flexible cuttingcomponent.

In an aspect, the elongated flexible cutting component is included in areplaceable cartridge. In an aspect, a single unit of elongated flexiblecutting component is included in a replaceable cartridge. In an aspect,a multiunit supply of elongated flexible cutting component is includedin a replaceable cartridge. For example, the elongated flexible cuttingcomponent may be included in a replaceable cartridge that attaches tothe tissue cutting device. For example, the elongated flexible cuttingcomponent may be fed out from one end of a cartridge to attach to eitherthe moveable component or the second end of the central rotatable shaft.For example, a replaceable cartridge, e.g., a spool, including a reserveof the elongated flexible cutting component may be associated withcentral rotatable shaft or the moveable component. In an aspect, thereplaceable cartridge including a source of the elongated flexiblecutting component is incorporated into the moveable component. In anaspect, the replaceable cartridge including a source of the elongatedflexible cutting component is incorporated into the central rotatableshaft. In an aspect, the replaceable cartridge including the elongatedflexible cutting component is disposed in a lumen defined by the centralrotatable shaft, the replaceable cartridge configured to allow theelongated flexible cutting component to be fed out the central rotatableshaft and secured to the moveable component.

Aspiration Component

In an aspect, the tissue cutting device includes an aspiration componentconfigured to aspirate tissue debris in proximity to the centralrotatable shaft. In an aspect, the aspiration component includes avacuum source and an aspirator connected to the vacuum source. Forexample, the tissue cutting device can include and aspiration componentto aspirate tissue debris created during tissue cutting with therotating elongated flexible cutting component of the tissue cuttingdevice.

In an aspect, the aspirator includes a suction tube positioned proximalto the central rotatable shaft, the suction tube connected to the vacuumsource. FIG. 6 illustrates a non-limiting embodiment of a tissue cuttingdevice including a suction tube. FIG. 6 shows tissue cutting device 600including central rotatable shaft 610 operably coupled to motor 120.Elongated flexible cutting component 140 is shown attached at a firstend to moveable component 130 and at a second end to central rotatableshaft 610. Tissue cutting device 600 further includes vacuum source 620.Vacuum source 620 is in fluid communication with suction tube 630.Suction tube 630 extends from handle casing 640 into a region inproximity to central rotatable shaft 610 and is configured to aspiratetissue debris resected by the rotating elongated flexible cuttingcomponent 140.

In an aspect, the aspirator includes a suction lumen disposed in anddefined by the central rotatable shaft, the suction lumen connected tothe vacuum source and in fluid communication with one or more openingsdefined by the central rotatable shaft. In an aspect, the one or moreopenings defined by the central rotatable shaft include a singleopening. For example, the one opening can be positioned at or near theend of the central rotatable shaft. FIG. 7 illustrates a non-limitingembodiment of a tissue cutting device including a suction lumen and oneopening defined by the central rotatable shaft. FIG. 7 shows tissuecutting device 700 including central rotatable shaft 710 operablycoupled to motor 120. Elongated flexible cutting component 140 is shownattached at a first end to moveable component 130 and at a second end tocentral rotatable shaft 710. Tissue cutting device 700 further includesvacuum source 720. Central rotatable shaft 710 further includes asuction lumen 730 disposed in and defined by central rotatable shaft710. Suction lumen 730 is connected to vacuum source 720 and is in fluidcommunication with an opening 740 defined by central rotatable shaft710. In this non-limiting embodiment, tissue cutting device 700 isconfigured to aspirate tissue debris generated by the rotation ofelongated flexible cutting component 140 into opening 740, aspirate thedebris through suction lumen 730, and into vacuum source 720.

In an aspect, the one or more openings defined by the central rotatableshaft are positioned along the length of the central rotatable shaft.For example, the tissue cutting device can include a single openingsomewhere along the length of the central rotatable shaft. For example,the tissue cutting device can include a plurality of openings positionedalong the length of the central rotatable shaft. FIG. 8 illustrates anon-limiting embodiment of a tissue cutting device including a suctionlumen and a plurality of openings defined by the central rotatableshaft. FIG. 8 shows tissue cutting device 800 including centralrotatable shaft 810 operably connected to motor 120. Elongated flexiblecutting component 140 is attached at a first end to moveable component130 and at a second end to central rotatable shaft 810. Tissue cuttingdevice 800 further includes vacuum source 820. Central rotatable shaft810 further includes a suction lumen 830 disposed in and defined bycentral rotatable shaft 810. Suction lumen 830 is connected to vacuumsource 820 and is in fluid communication with openings 840 defined byand positioned along the length of central rotatable shaft 810. In thisnon-limiting embodiment, tissue cutting device 800 is configured toaspirate tissue debris generated by the rotation of elongated flexiblecutting component 140 into openings 840, aspirate the debris throughsuction lumen 830, and into vacuum source 820.

In an aspect, the vacuum source is at least partially contained within ahand-held housing of the tissue cutting device. For example, vacuumsource can include any of a number of small, commercially available minivacuum pumps sized for use in small appliances (from, e.g., Vaccon Co,Inc., Medway, Mass.; Hargraves Technology Corp, Mooresville, N.C.). Inan aspect, the vacuum source is external to the tissue cutting device,e.g., a large vacuum pump, but connected, e.g., by a fitting, luer, orconnection, to the aspirator through a vacuum conduit, e.g., a hose ortubing. In an aspect, the external vacuum source includes an aspiratorpump, e.g., a water aspirator.

In an aspect, the tissue cutting device further includes a tissue debrisreservoir. In an aspect, the tissue debris reservoir includes a space(e.g., a receptacle) defined by the tissue cutting device and isconfigured to hold tissue debris aspirated by the aspiration component.In an aspect, the tissue debris reservoir is positioned along the flowpath of the aspiration component. For example, a tissue debris reservoircan be positioned along the path of the aspirator. In an aspect, thetissue debris reservoir is accessible to a user. For example, resectedtissue can be collected in the tissue debris reservoir and removed foranalysis following a cutting procedure to assess disease presence and/orprogression (e.g., benign versus malignant pathology).

FIG. 9 illustrates further non-limiting aspects of a tissue cuttingdevice. FIG. 9 shows tissue cutting device 900 including centralrotatable shaft 910 operably connected at a first end to motor 920.Motor 920 includes circuitry configured to rotate central rotatableshaft 910. Elongated flexible cutting component 940 is secured at afirst end to moveable component 930 and at a second end to the centralrotatable shaft 910. Moveable component 930 is configured to move alongat least a portion of the length of central rotatable shaft 910.Movement of moveable component 930 along the at least a portion of thelength of central rotatable shaft 910 changes a shape formed byelongated flexible cutting component 940.

In an aspect, tissue cutting device 900 includes a computing component945 operably coupled to at least one of the motor 920 and the moveablecomponent 930. In an aspect, computing component 945 includes circuitryconfigured to control motor 920. In an aspect, computing component 945includes circuitry configured to control moveable component 930.

In some embodiments, tissue cutting device 900 includes an aspirationcomponent configured to aspirate tissue debris in proximity to centralrotatable shaft 910. The aspiration component includes vacuum source 950and an aspirator 952 connected to vacuum source 950. In someembodiments, tissue cutting device includes at least one analyte sensor960 configured to sense a property of one or more analytes in anaspirate. In some embodiments, tissue cutting device 900 includes anirrigation component configured to irrigate tissue in proximity to thecentral rotatable shaft. In an aspect, the irrigation component includesa flow conduit 956 attached to an irrigation fluid reservoir 955. In anaspect, irrigation fluid reservoir 955 is configured to hold andcontrollably release at least one irrigation fluid. In some embodiments,a tissue cutting device includes an aspiration component and anirrigation component.

In some embodiments, tissue cutting device 900 includes an image-capturedevice 965. In an aspect, image-capture device 965 is operably coupledto computing component 945. In an aspect, computing component 945includes circuitry configured to receive one or more images fromimage-capture device 965. In some embodiments, tissue cutting device 900includes a torque compensation component 970, the torque compensationcomponent including circuitry configured to prevent axial oscillationwhen performing asymmetric cutting patterns. In some embodiments, tissuecutting device 900 includes a drag compensation component 975, the dragcompensation component including circuitry configured to measureresistance from the elongated flexible cutting component during rotationand to adjust a rotational speed. In some embodiments, tissue cuttingdevice 900 includes a cautery component 980, the cautery componentconfigured to cauterize tissue during a cutting process. In an aspect,the tissue cutting device 900 includes a power source 985. In an aspect,tissue cutting device 900 further includes a handle casing 990.

Computing Component

In an aspect, a tissue cutting device includes a computing component. Inan aspect, the computing component includes a processor. In an aspect,the computing component is operably connected to one or more componentsof the tissue cutting device. In an aspect, the computing componentincludes circuitry configured to control the function of one or morecomponents of the tissue cutting device. In an aspect, the computingcomponent includes circuitry to execute one or more instructions forcontrolling one or more functions of one or more components of thetissue cutting device. In an aspect, the computing component is operablycoupled to at least one of the motor and the moveable component. In anaspect, the computing component includes circuitry configured to controlthe motor. For example, the computing component can include circuitryconfigured to control an on/off function of the motor and/or therotational frequency of the motor. In an aspect, the computing componentis operably coupled to a second motor (e.g., a motor associated with atethering component). In an aspect, the computing component includescircuitry configured to control the moveable component. For example, thecomputing component can control an on/off function of the moveablecomponent. For example, the computing component can control at least oneof speed of the moveable component, directionality of the moveablecomponent, and distance traveled by the moveable component. In anaspect, the computing component includes circuitry configured to controlmovement of the moveable component in coordination with rotational speedof the central rotatable shaft and associated elongated flexible cuttingcomponent to generate an asymmetric cutting pattern.

In an aspect, the computing component is operably coupled to othercomponents of the tissue cutting device, non-limiting examples of whichinclude an aspiration component, an irrigation component, animage-capture device, at least one analyte sensor, a torque compensationcomponent, a drag compensation component, and/or a cautery component. Inan aspect, the computing component includes circuitry configured tocontrol one or more functions of an aspiration component, an irrigationcomponent, an image-capture device, at least one analyte sensor, atorque compensation component, a drag compensation component, and/or acautery component associated with the tissue cutting device.

In an aspect, the computing component includes a microprocessor, e.g., acentral processing unit, for controlling one or more functions of one ormore components of the tissue cutting device. The computing componentfurther includes a system memory and a system bus that couples varioussystem components including the system memory to the microprocessor. Themicroprocessor can include a processing unit, a central processing unit(CPU), a digital signal processor (DSP), an application-specificintegrated circuit (ASIC), a field programmable gate entry (FPGA), orthe like, or any combinations thereof, and can include discrete digitalor analog circuit elements or electronics, or combinations thereof. Inan aspect, the computing component includes one or more ASICs having aplurality of pre-defined logic components. In an aspect, the componentincludes one or more FPGA having a plurality of programmable logiccommands.

In some embodiments, the computing component is connected to a userinterface, e.g., one or more input components and/or output componentsfor use by a user to interface with the tissue cutting device. The oneor more input components can be used to enter information into thetissue cutting device, e.g., rotational frequency of the motor and/orrate and distance movement of the moveable component, and may beintegrated into the tissue cutting device or may be one or moreperipheral devices operably connected through a wired or wirelessconnection to the tissue cutting device. Non-limiting examples of inputcomponents include a graphical user interface, a display, a keyboard, akeypad, a touch-screen, a microphone, a stylus pen, a switch, a dial, orthe like. In some embodiments, the user interface is user driven. Forexample, the user inputs data or operating conditions into the tissuecutting device using the user interface, e.g., a touch-screen. In someembodiments, the user interface, e.g., a switch, is circuitry driven.For example, an on/off switch may be toggled based on proximity of aportion of the tissue cutting device, e.g., the central rotatable shaft,to the skin surface of an individual.

In an aspect, the user interface can include one or more outputcomponents over which processed information is viewed as output resultsand may be integrated into the tissue cutting device or may be one ormore peripheral devices operably connected through a wired or wirelessconnection to the tissue cutting device. For example, the user interfacemay be used to report to a user one or more of a speed of rotation, arate/distance, a shape formed by the elongated flexible cuttingcomponent, an identity of sensed analyte, one or more images captured byan image-captured device, drag compensation, torque compensation, tissueresection pattern, and the like. Non-limiting examples of outputcomponents include but are not limited to television screens, computermonitors, liquid crystal displays, audio speakers, audio headphones, andprinters.

In an aspect, the one or more input/output components are connected tothe microprocessor of the computing component through one or more userinput interfaces that are coupled to the system bus, but may beconnected by other interfaces and bus structures, such as a parallelport, game port, or a universal serial bus (USB). For example, externalinput components or output components may be connected to themicroprocessor through a USB port. The computing component may furtherinclude or be capable of connecting to a flash card memory. Thecomputing component may further include or be capable of connecting witha network through a network port and network interface, and throughwireless port and corresponding wireless interface may be provided tofacilitate communication with other peripheral devices, for example, asmart phone, a computer, a display monitor, and/or a printer.

In an aspect, the computing component is operably coupled to atransmission unit. A “transmission unit,” as used herein, can be one ormore of a variety of units that are configured to send and/or receivesignals, such as signals carried as electromagnetic waves. Atransmission unit generally includes at least one antenna and associatedcircuitry. A transmission unit can include a transmitter and a receiver.A transmission unit can include volatile or non-volatile memory. Atransmission unit can include a processor and/or be operably connectedto a processor. A transmission unit can be operably connected to anenergy source, such as a battery. A transmission unit can include anenergy harvesting unit, such as a unit configured to obtain energy fromelectromagnetic waves. A transmission unit can include a transponderutilizing electromagnetic waves, for example as described in“Fundamental Operating Principles,” in Chapter 3 of the RFID Handbook:Fundamentals and Applications in Contactless Smart Cards andIdentification, Klaus Finkenzeller, John Wiley & Sons, (2003), which isincorporated herein by reference. A transmission unit can include anoscillator and encoder configured to generate a programmable pulseposition-modulated signal in the radio frequency range (see, e.g., U.S.Pat. No. 4,384,288, which is incorporated herein by reference). Atransmission unit can include a radio frequency identification device(RFID), which can be a passive RFID device, a semi-passive RFID device,or an active RFID device, depending on the embodiment (see, e.g., Chawla& Ha, “An Overview of Passive RFID,” IEEE Applications and Practice,11-17 (September 2007), which is incorporated herein by reference). Atransmission unit including an RFID device can be configured to transmitsignals in the UHF standard range. A transmission unit can include abattery-assisted passive RFID device, such as sold by Alien Technology®,Morgan Hill, Calif. A transmission unit can include an opticaltransmission unit. A transmission unit can include a hybrid backscattersystem configured to function in an RFID, IEEE 802.11x standard andBluetooth system (see, e.g., U.S. Pat. No. 7,215,976, which isincorporated herein by reference). A transmission unit can include anear field communication (NFC) device. A transmission unit can include aWireless Identification and Sensing Platform (WISP) device.

In an aspect, image-based applications such as viewers and/or toolkits(e.g., Insight Segmentation and Registration Toolkit (ITK)), areincorporated for further intake of information. In an aspect, CADimplementations, image segmentation, or other image analysis algorithmsmay allow processing of images received from an image-capture deviceand/or from at least one analyte sensor.

The computing component can further include memory chips, e.g., ROM orflash memory chips, for providing storage of operating systems, look-uptables, and algorithms for comparing input data with reference data. Thesystem memory of the computing component may include read-only memory(ROM) and random access memory (RAM). A number of program modules may bestored in the ROM or RAM, including an operating system, one or moreapplication programs, other program modules and program data.

The computing component includes computer-readable media products andmay include any media that can be accessed by the computing componentincluding both volatile and nonvolatile media, removable andnon-removable media. By way of example, and not of limitation,computer-readable media may include non-transitory signal-bearing media.Non-limiting examples of non-transitory signal-bearing media include arecordable type medium such as magnetic tape, a hard disk drive, digitaltape, computer memory, or the like, as well as transmission type mediumsuch as a digital and/or analog communication medium (e.g., fiber opticcable, waveguide, wired communications link, wireless communicationlink). Further non-limiting examples of signal-bearing media include,but are not limited to, flash memory, magnetic tape, MINIDISC,non-volatile memory card, EEPROM, optical disk, optical storage, RAM,ROM, system memory, web server, cloud, or the like. By way of example,and not of limitation, computer-readable media may include computerstorage media, e.g., magnetic tape, magnetic disk storage, optical diskstorage, memory cards, flash memory cards, electrically erasableprogrammable read-only memory (EEPROM), solid state RAM, and solid stateROM or any other medium which can be used to store the desiredinformation and which can be accessed by the computing component. By wayof further example, and not of limitation, computer-readable media mayinclude a communication media, e.g., wired media, such as a wirednetwork and a direct-wired connection, and wireless media such asacoustic, RF, optical, and infrared media.

Irrigation Component

In some embodiments, as shown in FIG. 9, a tissue cutting deviceincludes an irrigation component configured to irrigate tissue inproximity to the central rotatable shaft, the irrigation componentincluding a flow conduit attached to an irrigation fluid reservoir. Inan aspect, the irrigation fluid reservoir is configured to hold andcontrollably release at least one irrigation fluid. In an aspect, theirrigation fluid reservoir is operably coupled to a computing component,the computing component including circuitry configured to controlrelease of at least one irrigation fluid. In some embodiments, the flowconduit includes an irrigation tube positioned in proximity to thecentral rotatable shaft, the irrigation tube connected to the irrigationfluid reservoir. For example, the tissue cutting device can include anirrigation fluid reservoir holding at least one irrigation fluid and anirrigation tube extending from the irrigation fluid reservoir to alocation in proximity to the central rotatable shaft. In someembodiments, the flow conduit includes an irrigation lumen disposed inand defined by the central rotatable shaft, the irrigation lumenconnected to the irrigation fluid reservoir and in fluid communicationwith one or more openings defined by the central rotatable shaft. Forexample, the central rotatable shaft can include an irrigation lumenthat runs along at least a portion of the inner length of the centralrotatable shaft with an opening at the second end of the centralrotatable shaft from which an irrigation fluid is expelled. In anaspect, the irrigation tube is in fluid communication with one or moreopenings defined by the central rotatable shaft. For example, thecentral rotatable shaft can include one or more openings, e.g., pores,through the irrigation fluid is expelled.

In an aspect, the irrigation fluid reservoir is configured to hold andcontrollably release at least one irrigation fluid. In an aspect, the atleast one irrigation fluid helps to fluidize the resected tissue. In anaspect, the at least one irrigation fluid treats a condition of theremaining tissue. For example, the irrigation fluid can include one ormore components to prevent infection (e.g., one or more antimicrobialagents). For example, the irrigation fluid can include one or morecomponents to treat a malignancy (e.g., one or more chemotherapyagents). In an aspect, the at least one irrigation fluid includes atleast one of saline, a buffer, a therapeutic agent, an antimicrobialagent, an anesthetic, or a coagulant agent. In an aspect, the at leastone irrigation fluid includes saline, the saline used to irrigate thetissue before, during, and/or after resection of tissue with therotating elongated flexible cutting component. For example, theirrigation fluid can include a physiological sodium chloride saltsolution. In an aspect, the at least one irrigation fluid includes abuffer. For example, the at least one irrigation fluid can include abuffer to maintain a physiological pH before, during, and/or after acutting procedure. For example, the at least one irrigation fluid caninclude a buffer to maintain a pH above or below a physiological pHbefore, during, and/or after a cutting procedure. In an aspect, the atleast one irrigation fluid includes a buffer, the buffer used toirrigate the tissue before, during, and/or after resection of tissuewith the rotating elongated flexible cutting component. For example, thebuffer can include phosphate buffered saline.

In an aspect, the irrigation fluid includes at least one therapeuticagent, the at least one therapeutic agent added to the tissue before,during, and/or after cutting of tissue with the rotating elongatedflexible cutting component. For example, the at least one irrigationfluid can include an anti-inflammatory agent, non-limiting examples ofwhich include dexamethasone, prednisolone, corticoserone, budesonide,estrogen, sulfasalazine, and mesalamine. For example, the at least oneirrigation fluid can include a chemotherapeutic agent, added before,during, and/or after resection of tissue with the rotating elongatedflexible cutting component. Non-limiting examples of chemotherapy agentsinclude alkylating agents (e.g., nitrosoureas, tetrazines, aziridines,cisplatin, procarbazine, and hexamethylmelamine), anti-metabolites(e.g., methotrexate, pemetrexed, fluorouracil, capecitabine,gemcitabine, decitabine, and pentostatin), anti-microtubule agents(e.g., vinca alkaloid and taxanes), topoisomerase inhibitors (e.g.,irinotecan, topotecan, eoposide, doxorubicin, and teniposide), andcytotoxic antibiotics (e.g., anthracyclines, actinomycin, bleomycin,plicamycin, and mitomycin.

In an aspect, the irrigation fluid includes at least one antimicrobialagent, the at least one antimicrobial agent added to the tissue before,during, and/or after resection of tissue with the rotating elongatedflexible cutting component. For example, the at least one irrigationfluid can include one or more antibiotics added to a region of tissuebefore, during, and/or after the elongated flexible cutting component isresecting tissue pieces to prevent bacterial infection at the cuttingsite. Non-limiting examples of antibiotics used prophylactically forsurgical procedures include ampicillin, aztreonam, cefazolin,cefuroxime, cefotaxime, cefoxitin, cefotetan, ceftriaxone,ciprofloxacin, clindamycin, ertapenem, fluconazole, gentamicin,levofloxacin, metronidazole, moxifloxacin, piperacillin-tazobactam, andvancomycin.

In an aspect, the at least one irrigation fluid includes ananticoagulant agent. For example, at least one anticoagulant can beadded before and/or during the cutting procedure to prevent bloodclotting and aide in tissue removal. Non-limiting examples ofanticoagulant agents include anti-thrombotic agent such as, for example,heparin, heparin derivatives, urokinase, platelet inhibitors, hirudin,and dextrophenylalanine praline arginine chloromethylketone (Ppack).

In an aspect, the at least one irrigation fluid includes a coagulantagent. For example, at least one coagulant agent can be added before,during, and/or after the cutting procedure to reduce or stop bleeding.For example, the at least one irrigation fluid can include adding one ormore coagulant agents, e.g., zeolites, thrombin, or fibrin glue, before,during, and/or after the elongated flexible cutting component isresecting tissue pieces. Other non-limiting examples of coagulant agentsinclude aminocaproic acid, confugated estrogen, desmopressin, plasma,factor 7A, phytonadione, protamine, prothrombin complex, or tranexamicacid.

In an aspect, the at least one irrigation fluid includes an anestheticagent. Non-limiting examples of anesthetic agents include lidocaine,bupivacaine, and ropivacaine. In an aspect, the at least one irrigationfluid includes an analgesic agent. Non-limiting examples of analgesicagents include opioid analgesics (e.g., codeine, fentanyl, meperidine,methadone, morphine, pentazocine, and tramadol) and non-opioidanalgesics (e.g., etodolac, fenoprofen, ketoprofen, ketorolac,paracetamol, aspirin, diclofenac, ibuprofen, indomethacin, and naproxen.

In an aspect, the irrigation component includes at least onecontrollable valve, the at least one controllable valve operably coupledto a computing component. For example, the controllable valve caninclude a controllable gate, door, port, diaphragm, erodible barrier, orany other type of controllable valve configured to hold and controllablyrelease at least one irrigation fluid from the irrigation component. Inan aspect, the at least one controllable valve is associated with theirrigation fluid reservoir. In an aspect, the at least one controllablevalve is associated with the flow conduit.

In some embodiments, a tissue cutting device includes an aspirationcomponent and an irrigation component. In an aspect, the aspirationcomponent and the irrigation component function simultaneously. Forexample, the aspiration component may be aspirating tissue debris at thesame time the irrigation component is providing an irrigation fluid. Inan aspect, the aspiration component and the irrigation component arefunctioning sequentially. For example, the irrigation component mayprovide an irrigation fluid (e.g., saline or a buffer) followed by theaspiration component aspirating the irrigation fluid in combination withassociated tissue debris. For example, the aspiration component mayaspirate tissue debris from a tissue site followed by irrigation of thetissue site with an irrigation fluid (e.g., a coagulant to stopbleeding, a neoplastic agent to kill any remaining cancerous cells, oran antibiotic to prevent infection post tissue resection).

Image-Capture Device

In some embodiments, as shown in FIG. 9, a tissue cutting deviceincludes an image-capture device. In an aspect, the image-capture deviceis used to guide a tissue cutting procedure. For example, imagingguidance can be used to determine the location of the tissue to beremoved and to monitor removal of tissue during the tissue cuttingprocedure. In an aspect, the image-capture device is operably coupled toa computing component, the computing component including circuitryconfigured to receive one or more images from the image-capture device.In an aspect, the image-capture device is configured to capture one ormore images of the tissue during the resection process. In an aspect,the image-capture device is configured to capture one or more images todocument the progress of the resection process. For example, the imagescapture device can capture one or more images to document how muchtarget tissue remains, the shape of the remaining target tissue, thepathology of the remaining target tissue, other targets or off-targetsin the resection field. For example, the image-capture device cancapture one or more images of blood vessels and/or nerves that mightconfound the resection process. In an aspect, the computing componentincludes circuitry configured to alter a function of one or more othercomponents of the tissue cutting device in response to the received oneor more images from the image-capture device. For example, the computingcomponent can include circuitry configured to alter a function of atleast one of the motor and the moveable component to change a shapeformed by the elongated flexible cutting component in response to thereceived one or more images. For example, the computing component caninclude circuitry configured to alter a function of an aspirationcomponent, an irrigation component, at least one analyte sensor, and/orthe cautery component in response to the received one or more images.

In an aspect, the one or more images captured with the image-capturedevice are representative of one or more properties of the tissue or itsconstituents (e.g., cells, blood vessels, nerves, connective tissue,adipose tissue, and the like). The one or more properties can includeone or more inherent properties or characteristics of the tissue or itsconstituents that are measureable by the image-capture device. In anaspect, the one or more properties of the tissue or its constituents caninclude at least one of an optical property, autofluorescence property,an infrared spectral property, a reflective property, a light scatteringproperty, or an opacity property of the tissue. In an aspect, the one ormore properties of the tissue or its constituents can include one ormore of a size, a morphological property, or a physical feature of thetissue or its constituents.

In an aspect, the image-capture device includes an optical image-capturedevice. For example, the image-capture device can include a camera forcapturing photographic images of the tissue. For example, theimage-capture device can include components of a laparoscope, e.g., atelescopic rod lens system connected to a video camera. For example, theimage-capture device can include a miniature digital video camera, e.g.,a charge-coupled device, located at or near the end of the tissuecutting device. In an aspect, the image-capture device further includesa light source, e.g., a fiber optic cable connected to a light source(e.g., halogen or xenon) to illuminate the field for capturing images.

In an aspect, the optical image-capture device includes circuitryconfigured to capture one or more images in at least one of ultraviolet,visible, or infrared wavelengths. In an aspect, the opticalimage-capture device includes circuitry configured to capture one ormore images of fluorescence emitted from the tissue during the resectionprocess. In an aspect, the optical image-capture device includescircuitry configured to capture one or more images of autofluorescenceemitted from the tissue during the resection process. In an aspect, anautofluroescence signal emitted from a tissue during the resectionprocess includes an autofluorescence signal emitted by a normal tissueor an abnormal tissue, e.g., a cancerous or diseased tissue. In anaspect, the optical image-capture device includes circuitry configuredto capture one or more images of fluorescence emitted from one or morefluorescing agents associated with the tissue. For example, afluorescing agent that specifically binds cancerous cells or otherdiseased cells can be given to a subject prior to the cutting procedureto fluorescently mark the cancerous cells or other diseased cells. Forexample, a fluorescing agent that specifically binds cancerous cells orother diseased cells can be applied to the tissue during the cuttingprocedure.

In an aspect, the image-capture device is configured to capture one ormore signals emitted from the tissue before, during, and/or after theresection process. In an aspect, the one or more signals include one ormore optical signals, one or more fluorescence signals, one or moreacoustic signals, one or more electrical signals, one or more magneticsignals, one or more radiofrequency signals, or one or moreelectromagnetic signals. In an aspect, the image-capture device uses anyof a number of imaging or optical methods including but not limited tolight scattering, electrical impedance, infrared spectroscopy, acousticimaging, thermal imaging, photothermal imaging, dark field, visiblelight absorption and refraction, and autofluorescence. In an aspect, theimage-capture device measures the absorption, emission, fluorescence,luminescence, chemiluminescence, and/or phosphorescence from the tissue.

In an aspect, the image-capture device includes at least one camera,e.g., a digital camera, configured to capture one or more images. In anaspect, the at least one camera may capture one or more images in thevisible spectrum. In an aspect, the at least one camera may capture oneor more images in other portions of the electromagnetic spectrum, e.g.,infrared or ultraviolet. In an aspect, the at least one camera maycapture emitted and/or reflected light. The image-capture device caninclude one or more electronic image sensors, e.g., photodiodes,photoresistors, charge-coupled devices (CCD), and/or complementary metaloxide semiconductor (CMOS) devices. In an aspect, the image-capturedevice includes a single-shot capture device with one CCD with a Bayerfilter mosaic or three separate image sensors, which are exposed to thesame image via a beam splitter. In an aspect, the image-capture deviceincludes a multi-shot capture device. For example, a single CCD sensormay obtain additive color information by capturing an image three times,each with a different filter (e.g., red, green, and blue). For example,the CCD sensor may capture images as it is moved to various locations onthe focal plane and a high resolution composite image “stitched”together. In an aspect, the image-capture device includes a scanningdevice in which the sensor moves across the focal plane. For example,the camera can include a rotating line camera with a linear CCD array toassemble a high resolution digital image as the camera rotates. Cameracan include an area array of CCD or CMOS sensors. Camera can include alinear array of CCD (monochrome) or 3-strip CCD with color filters.

In an aspect, the image-capture device includes an ultrasoundimage-capture device. In an aspect, the ultrasound image-capture deviceproduces sounds waves, receives echoes from said sound waves, and/orinterprets the echoes. In an aspect, the ultrasound image-capture deviceuses continuous waves. In an aspect, the ultrasound image-capture deviceuses pulsed waves. In an aspect, the ultrasound image-capture deviceuses frequencies of about 1 megahertz to about 18 megahertz. In someembodiments, lower or higher frequencies are used. In some embodiments,the ultrasound image-capture device includes a piezoelectric transduceror a capacitive micromachined transducer. In an aspect, the ultrasoundimage-capture device uses one or more modes. For example, the ultrasoundimage-capture device can use one or more of A-mode, B-mode/2D mode,C-mode, M-mode, Doppler mode, pulse inversion mode, and/or harmonicmode. In an aspect, the ultrasound image-capture device includes atransducer and a low frequency transmitter for ultrasound elasticityimaging. For example, the ultrasound image-capture device may include atransducer for imaging a tissue region over time while the low frequencytransmitter is used to perturb and oscillate the tissue region. Underthese conditions, healthy tissue will oscillate differently thanunhealthy tissue. In an aspect, the ultrasound image-capture deviceincludes one or more features of a hand-held ultrasound image-capturedevice. See, e.g., U.S. Pat. No. 8,128,568 to Wang et al. titled“Handheld volumetric ultrasound scanning device;” and U.S. Pat. No.8,808,295 to Vercellotti et al. titled “Insert for a handheld ultrasoundsurgical device;” which are incorporated herein by reference.

In an aspect, the image-capture device includes one or more imagingsensors including, but not limited to, one or more piezo transducers,one or more MEMS device, one or more cavity resonators, one or moremagneto resistive sensors, one or more magnetic field sensors, and/orone or more thermal sensors. In an aspect, the image-capture deviceincludes one or more electromagnetic energy sensors, one or moreacoustic sensors, one or more photodetectors, one or more radiofrequencyantennae, one or more magnetic energy sensors, one or more thermalsensors, and/or one or more electrical energy sensors. The one or moreelectromagnetic energy sensors can include one or more optical sensorsincluding, but not limit to, sensors configured to detect near infrared,ultraviolet, fluorescence, and/or visual light emitted from the tissue.

Analyte Sensor

In some embodiments, as shown in FIG. 9, a tissue cutting deviceincludes at least one analyte sensor. In an aspect, the at least oneanalyte sensor includes at least one of an optical sensor, a magneticsensor, an electrical sensor, an acoustic sensor, or a chemical sensor.In an aspect, the at least one analyte sensor is configured to sense aproperty of one or more analytes in an aspirate. For example, the atleast one analyte sensor can be used to determine whether the aspirate,e.g., tissue debris, contains disease-associated analytes, e.g.,disease-associated molecules or cells. For example, the at least oneanalyte sensor can be used to determine whether the aspirate containstumor markers or cancerous cells. In an aspect, the at least one analytesensor is configured to sense an optical property, fluorescenceproperty, magnetic property, electrical property, electromagneticproperty, acoustic property, or chemical property of the one or moreanalytes in the aspirate. In an aspect, the at least one analyte sensoris operably coupled to a computing component, the computing componentincluding circuitry configured to receive an input from the at least oneanalyte sensor and to adjust the function of at least one component ofthe tissue cutting device in response to the received input. Forexample, the computing component trigger movement of the moveablecomponent to change the shape formed by the elongated flexible cuttingcomponent in response to detecting the presence of neoplastic cells atthe margins of the resected tissue.

In an aspect, the at least one analyte sensor includes at least onepiezo transducer, MEMS device, cavity resonator, magneto resistivesensor, magnetic field sensors, and/or thermal sensor. In an aspect, theat least one analyte sensor includes one or more electromagnetic energysensors, one or more acoustic sensors, one or more photodetectors, oneor more radiofrequency antennae, one or more magnetic energy sensors,one or more thermal sensors, and/or one or more electrical energysensors. The one or more electromagnetic energy sensors can include oneor more optical sensors including, but not limit to, sensors configuredto detect near infrared, ultraviolet, fluorescence, and/or visual light.

In an aspect, the at least one analyte sensor is configured to sense aninherent property of one or more analytes in an aspirate. In an aspect,the one or more analytes can include one or more cell types (e.g., bloodcells, organ cells, connective tissue cells, nerve cells, neoplasticcells, diseased cells, and the like) in the aspirate. In an aspect, theone or more analytes can include one or more biomolecules (e.g.,proteins, lipids, nucleotides, and polysaccharides) in the aspirate. Forexample, the one or more analytes can include one or more types ofbiomolecules found in the tissue milieu. For example, the one or moreanalytes can include one or more types of biomolecules released from thetissue cells during the cutting procedure. For example, the at least oneanalyte sensor can be configured to sense an inherent property of abiomolecule or a cell. For example, the at least one analyte sensor canbe configured to sense an inherent autofluorescence property of abiomolecule or a cell. For example, the at least one analyte sensor canbe configured to sense an inherent chemical property of a biomolecule.

In an aspect, the at least one analyte sensor is configured to sense aproperty of one or more signaling agents interacting with one or moreanalytes in an aspirate. For example, one or more signaling agentsdesigned to recognize and/or interact with diseased cells and/orbiomolecules can be added before and/or during a cutting and aspirationprocedure. The one or more signaling agents can include one or moreantibodies, aptamers, ligands, receptors, oligonucleotides or otherbinding agents labeled with a marker (e.g., an optical, fluorescent,acoustic, magnetic, radioactive, RFID tag, or chemical marker) that canbe detected by the at least one analyte sensor. For example, afluorescently labeled antibody designed to recognize and bind a tumorcell marker can be added before and/or during a tumor resectionprocedure and detected in an aspirate with the at least one analytesensor.

In an aspect, the at least one analyte sensor is configured to sense oneor more cell types. In an aspect, the at least one analyte sensor isconfigured to sense a physical property of a cell, e.g., cell size,deformability, compressibility, shape, density, surface properties,electrical polarizability, magnetic susceptibility, and/or refractiveindex. For example, circulating tumor cells can be distinguished fromred blood cells and/or white blood cells based on the relatively largersize of circulating tumor cells. In an aspect, the at least one analytesensor is configured to sense one or more cell types by recognizing oneor more cell-associated biomolecules with a binding agent, e.g., anantibody, aptamer, or oligonucleotide. For example, a target cell, e.g.,a cancer cell, can be captured using an antibody that recognizes andbinds to a cancer-specific cell marker. In an aspect, the at least oneanalyte sensor is configured to sense cancerous cell types. For example,the at least one analyte sensor can be configured to sense a cancerouscell type. For example, the at least one analyte sensor can beconfigured to sense a normal cell type.

In an aspect, the at least one analyte sensor is configured to sense adisease marker. For example, the at least one analyte sensor can beconfigured to sense a disease marker of diabetes, a metabolic disorder,a cardiovascular disease, a neurological disease, an inflammatorydisease, a gastrointestinal disease, urogenital disease, or a pulmonarydisease. In an aspect, the at least one analyte sensor is configured tosense a tumor marker. For example, the tumor marker can include proteintumor markers. Non-limiting examples of protein tumor markers includealpha-fetoprotein, beta-2-microglobulin, beta-human chorionicgonadotropin, CA15-3/CA27.29, CA19-9, CA-125, calcitonin, calretinin,carcinoembryonic antigen, CD20, CD34, CD45, CD99, CD117, chromogranin,cytokeratin fragment 21-1, desmin, epithelial membrane antigen, estrogenreceptor/progesterone receptor, fibrin/fibrinogen, glial fibrillaryacidic protein, HE4, HER2/neu, HMB-45, immunoglobulins, inhibin,keratin, KIT, lactate dehydrogenase, Myo-D1, neuron-specific enolase,nuclear matrix protein 22, prostate-specific antigen, placental alkalinephosphates, S100 protein, synaptophysin, thyroglobulin, tumor M2-PK,urokinase plasminogen activator, vimentin, 5-protein signature, Forexample, the tumor marker can include genetic tumor markers.Non-limiting examples of genetic tumor markers includes ALK generearrangements, BCR-ABL fusion gene, BRAF mutation V600E, chromosomes 3,7, 17, and 9p21, EGFR mutation, KRAS mutation, 21-gene signature,70-gene signature. In an aspect, the at least one analyte sensor isconfigured to detect a tumor marker associated with a tumor cell in theaspirate. In an aspect, the at least one analyte sensor is configured todetect a tumor marker free in the aspirate.

In an aspect, the at least one analyte sensor is associated with amicrofluidics component. In an aspect, all or part of an aspirate isprocessed using a microfluidics component associated with the tissuecutting device. Non-limiting examples of microfluidics devices foranalyzing tumor cells is described in Chen et al. (2014) “Rare cellisolation and analysis in microfluidics,” Lab Chip 14:626-645, which isincorporated herein by reference.

A variety of analytes sensors can be utilized in different embodimentsof a tissue cutting device, depending on factors such as the intendeduse of the tissue cutting device, target tissue, disease condition,sensed analyte, size, weight, cost, bio-compatibility, safety and easeof disposal. “Sensors,” as used herein, can be of a variety of typesdepending on the embodiment. One or more sensors can include at leastone sensor responsive to changes in capacitance, or a measure of theability of a configuration of materials to store electric charge. Ageneral review of biosensors that detect changes in the dielectricproperties of an electrode surface can be found in Berggren et al.,“Capacitive Biosensors,” Electroanalysis vol. 13, no. 3, 173-180,(2001), which is incorporated herein by reference. For example, the atleast one analytes sensors can include a micromechanical biosensor witha fixed-fixed beam attached to an interdigitated capacitor (see, forexample, Lim et al., “A Micromechanical Biosensor with InterdigitatedCapacitor Readout,” Proceedings of the 2011 IEEE/ICME InternationalConference on Complex Medical Engineering, May 22-25, Harbin, China,which is incorporated herein by reference). In an aspect, the at leastone analytes sensor can include nanowire nanosensors, for example asdescribed in Cui et al., “Nanowire Nanosensors for Highly Sensitive andSelective Detection of Biological and Chemical Species,” Science, vol.293, 1289-1292 (2001), which is incorporated herein by reference. In anaspect, the at least one analyte sensor can include those utilizingantibodies secured to a graphene substrate. See Tehrani et al.,“Detection of Monoclonal Antibodies using Chemically Modified GraphiteSubstances,” IEEE Sensors 2010 Conference Proceedings, 428-431, (2010),which is incorporated herein by reference. In some embodiments, the atleast one analytes sensor includes aptamer-modified graphenefield-effect transistors, see Ohno et al., “Graphene Field-EffectTransistors for Label-Free Biological Sensors,” IEEE Sensors 2010Conference Proceedings, 903-906, (2010), which is incorporated herein byreference. The at least one analyte sensor can include a field effecttransistor (FET), such as described in U.S. Pat. No. 7,507,675 toZuilhof et al., titled “Device Manufacturing Method and Device,” whichis incorporated herein by reference. The at least one analyte sensor caninclude a nano-cantilever device, such as described in U.S. Pat. No.7,612,424 to Espinosa and Ke, titled “Nanoelectromechanical BistableCantilever Device,” which is incorporated herein by reference.

In an aspect, the at least one analyte sensor includes a plasmonicbiosensor. For example, the tissue cutting device can include an analytesensor that includes components of a hand-held plasmonic microarray andcomputational on-chip imaging system such as described in Cetin et al.,(2014) “Handheld high-throughput plasmonic biosensor using computationalon-chip imaging,” Light: Science & Applications, 3, e122, which isincorporated herein by reference.

In an aspect, the at least one analyte sensor includes a radioactivitysensor. For example, the at least one analyte sensor can sense aradioactive property of an aspirate. For example, the at least oneanalyte sensor can sense a radioactive property of a radiotracer addedbefore and/or during the cutting process. Examples of detectors fordetecting radioactivity include, but are not limited to, gas-filled tubedetectors, e.g., Geiger counters; scintillation crystal detectors; andsolid-state semiconductor detectors. In some embodiments, the one ormore radioactivity sensors are one or more of a scintillation crystaldetector made from a material that fluoresces or emits light when hit byradiation particles. The fluorescence or light can be measured using oneor more optical sensors, e.g., a photomultiplier or photodiode. In anaspect, the one or more radioactivity sensors are one or more of amicrodosimeter. A microdosimeter for wireless measurement ofradioactivity in vivo has been described and is configured to detectionizing radiation using a parallel plate capacitor to form a passive LCresonator. See, e.g., Son & Ziaie. IEEE Trans. Biomed. Eng.55:1772-1775, 2008, which is incorporated herein by reference.

In an aspect, the at least one analyte sensor includes a magneticsensor. For example, the at least one analyte sensor can sense amagnetic property of an aspirate using one or more MEMS magnetic sensorssuch as described in Kim et al. (2006) “A class of micromachinedmagnetic resonator for high-frequency magnetic sensor applications,” J.Applied Phys. 99:08B309, which is incorporated herein by reference.

Torque Compensation

In some embodiments, the tissue cutting device includes a torquecompensation component. In an aspect, the torque compensation componentincludes circuitry configured to prevent oscillation when performingasymmetric cutting patterns. For example, the torque compensationcomponent can be configured to prevent oscillation of the tissue cuttingdevice when the cutting radius of the elongated flexible cuttingcomponent changes during the course of a single rotation to generate anasymmetric cutting pattern. In an aspect, the torque compensationcomponent includes at least one counterweight. FIGS. 10A-10C illustratenon-limiting aspects of a tissue cutting device including acounterweight. FIG. 10A shows tissue cutting device 1000. Tissue cuttingdevice 1000 includes central rotatable shaft 1010, motor 1020, moveablecomponent 1030, and elongated flexible cutting component 1040. Tissuecutting device 1000 further includes counterweight 1050 associated withthe central rotatable shaft 1010. Counterweight 1050 includes a pivotpoint 1060 around which counterweight 1050 can pivot as shown with arrow1070. Moveable component 1030 is positioned so that elongated flexiblecutting component 1040 is flattened against central rotatable shaft 1010and counterweight 1050 is aligned with central rotatable shaft 1010 tofacilitate insertion into a body or lumen through a small incision orlumen diameter. FIGS. 10B and 10C illustrate counterweight 1050 pivotingaround pivot point 1060 as motor 1020 rotates central rotatable shaft1010 through a single rotation and moveable component 1030 moves up anddown to change the shape of elongated flexible cutting component 1040 toform an asymmetric cutting pattern. FIG. 10B shows tissue cutting device1000 in a first state, e.g., at 0 degrees of a single rotation. In thisexample, motor 1020 is rotating central rotatable shaft 1010. Moveablecomponent 1030 is at a first position along the central rotatable shaft1010, causing the elongated flexible cutting component 1040 to form along and narrow D-shape. At this point, counterweight 1050 is shownpivoted around pivot 1060 to a first position. As motor 1020 continuesto rotate the central rotatable shaft 1010 through the rotation,moveable component 1030 moves along a path shown by arrow 1075 andcounterweight 1050 pivots along a path shown by arrow 1070. FIG. 10Cshows tissue cutting device 1000 in a second state, e.g., at 180 degreesof the single rotation. Moveable component 1030 is at a second positionalong the central rotatable shaft 1010, causing the elongated flexiblecutting component 1040 to form a short and wide D-shape. At this pointin the single rotation, counterweight 1050 is shown pivoted around pivot1060 to a second position. As motor 1020 continues to rotate centralrotatable shaft 1010 around towards the completion of a single rotation,moveable component 1030 moves along a path shown by arrow 1085 andcounterweight 1050 pivots along a path shown by arrow 1080. As thecentral rotatable shaft 1010 rotates, moveable component 1030 travels upand down changing the shape formed by elongated flexible cuttingcomponent 1040. Counterweight 1050 pivots back and forth around pivotpoint 1060 to counterbalance the changing shape formed by the elongatedflexible cutting component 1040.

In an aspect, the torque compensation component includes at least onecounterweight that is extendible. FIGS. 11A-11C illustrate non-limitingaspects of a tissue cutting device including an extendiblecounterweight. FIG. 11A shows tissue cutting device 1100. Tissue cuttingdevice 1100 includes central rotatable shaft 1110, motor 1120, moveablecomponent 1130, and elongated flexible cutting component 1140. Tissuecutting device 1100 further includes counterweight 1150 associated withthe central rotatable shaft 1110. Counterweight 1150 includes a pivotpoint 1160 around which counterweight 1150 can pivot as shown with arrow1170. Counterweight 1150 further includes a slide groove 1165 alongwhich counterweight 1150 can extend by sliding. Moveable component 1130is positioned so that elongated flexible cutting component 1140 isflattened against central rotatable shaft 1110 and counterweight 1150 isaligned with central rotatable shaft 1110 to facilitate insertion into abody or lumen through a small incision or lumen diameter. FIGS. 11B and11C illustrate counterweight 1150 pivoting around pivot point 1160 andextending along slide groove 1165 as motor 1120 rotates centralrotatable shaft 1110 through a single rotation and moveable component1130 moves up and down to change the shape of elongated flexible cuttingcomponent 1140 to form an asymmetric cutting pattern. FIG. 11B showstissue cutting device 1100 in a first state, e.g., at 0 degrees of asingle rotation. In this example, motor 1120 is rotating centralrotatable shaft 1110. Moveable component 1130 is at a first positionalong the central rotatable shaft 1110, causing the elongated flexiblecutting component 1140 to form a long and narrow D-shape. At this point,counterweight 1150 is shown pivoted around pivot 1160 to a firstposition. As motor 1120 continues to rotate the central rotatable shaft1110 through the rotation, moveable component 1130 moves along a pathshown by arrow 1175 and counterweight 1150 extends along slide groove1165 along a path shown by arrow 1190. FIG. 11C shows tissue cuttingdevice 1100 in a second state, e.g., at 180 degrees of the singlerotation. Moveable component 1130 is at a second position along thecentral rotatable shaft 1110, causing the elongated flexible cuttingcomponent 1140 to form a short and wide D-shape. At this point in thesingle rotation, counterweight 1150 is shown extended along slide groove1165 to a second position. As motor 1120 continues to rotate centralrotatable shaft 1110 around towards the completion of a single rotation,moveable component 1130 moves along a path shown by arrow 1185 andcounterweight 1150 retracts along slide groove 1165 along a path shownby arrow 1180. As the central rotatable shaft 1110 rotates, moveablecomponent 1130 travels up and down changing the shape formed byelongated flexible cutting component 1140. Counterweight 1150 extendsand retracts along slide groove 1165 and around pivot point 1160 tocounterbalance the changing shape formed by the elongated flexiblecutting component 1140.

In an aspect, the torque compensation component includes circuitry andmotors configured to control the position of the at least onecounterweight. In an aspect, the torque compensation component isoperably coupled to a computing component, the computing componentincluding circuitry configured to control the torque compensationcomponent.

Drag Compensation

In some embodiments, a tissue cutting device includes a dragcompensation component. For example, the tissue cutting device caninclude components to compensate for drag associated with the elongatedflexible cutting component rotating through a tissue mass. In an aspect,a tissue cutting device includes a drag compensation componentconfigured to prevent drag. For example, the tissue cutting device caninclude one or more stays (e.g., wires or strings) attached to theelongated flexible cutting component that prevent a portion of theelongated flexible cutting component from dragging or lagging behindduring the cutting process. FIGS. 12A and 12B illustrate non-limitingaspects of a drag compensation component. FIG. 12A shows tissue cuttingdevice 1200 including central rotatable shaft 1210, motor 1220, moveablecomponent 1230, and elongated flexible cutting component 1240. Tissuecutting device 1200 further includes spar 1250 and stays 1260. In theexample shown in FIG. 12A, spar 1250 is positioned at the end of centralrotatable shaft 1210. However, spar 1250 could be positioned at otherlocations along the central rotatable shaft 1210. Stays 1260 are securedto spar 1250 and to elongated flexible cutting component 1240. Spar 1250and stays 1260 are configured to rotate with the central rotatable shaft1210 and the elongated flexible cutting component 1240. Stays 1260 areconfigured to prevent elongated flexible cutting component 1240 fromlagging or dragging during rotation. FIG. 12B shows an end-on view oftissue cutting device 1200. Shown is the end of central rotatable shaft1210 with spar 1250 associated with central rotatable shaft 1210. Stays1260 are attached to spar 1250 at one end and to elongated flexiblecutting component 1240. Stays 1260 prevent elongated flexible cuttingcomponent 1240 from lagging (as illustrated with dashed line 1270)during rotation (as illustrated by arrow 1280).

In an aspect, the drag compensation component includes circuitryconfigured to measure drag from the elongated flexible cutting componentduring rotation. For example, the drag compensation component caninclude stays that attach to either side of the elongated flexiblecutting component and detect drag, e.g., a lagging edge, of theelongated flexible cutting component during a cutting process. Forexample, one or more tensions sensors can be associated with the staysto measure changes in the tension associated with the stays as theelongated flexible cutting component rotates. For example, the dragcompensation component can include a transceiver associated with thecentral rotatable shaft and at least one reflector associated with theelongated flexible cutting component to measure relative changes indistance between the central rotatable shaft and the elongated flexiblecutting component.

FIGS. 13A-C illustrate non-limiting aspects of a drag compensationcomponent including a transceiver and at least one reflector. FIG. 13Ashows a portion of tissue cutting device 1300 including centralrotatable shaft 1310, motor 1320, moveable component 1330, and elongatedflexible cutting component 1340. Tissue cutting device 1300 furtherincludes transceiver 1350, shown here associated with the second end ofthe central rotatable shaft 1310. Tissue cutting device 1300 furtherincludes at least one reflector 1360 associated with elongated flexiblecutting component. In an aspect, the transceiver can be configured totransmit and receive optical signals, acoustic signals, radiofrequencysignals, microwave signals, or electromagnetic signals. In an aspect,the at least one reflector reflects optical signals, acoustic signals,radiofrequency signals, microwave signals, or electromagnetic signals.In an aspect, transmission and receipt of a signal is used to determinea distance between the transceiver and the at least one reflector. FIG.13B shows an end-on view of tissue cutting device 1300. Shown is atransceiver 1350 associated with central rotatable shaft 1310. Alsoshown is reflector 1360 associated with elongated flexible cuttingcomponent 1340 in a first position. A signal transmitted by transceiver1350 and received back from reflector 1360 is used to measure length1370. FIG. 13C shows an end-on view of tissue cutting device 1300 inwhich the elongated flexible cutting component is experiencing lag ordrag during rotation (as illustrated by arrow 1390). Shown is atransceiver 1350 associated with central rotatable shaft 1310. Alsoshown is reflector 1360 associated with elongated flexible cuttingcomponent 1340 in a second position (e.g., lagging behind duringrotation). A signal transmitted by transceiver 1350 and received backfrom reflector 1360 is used to measure length 1380. In an aspect,transceiver 1350 of the drag compensation component is operably coupledto a computing component, the computing component including circuitryconfigured to control at least one of the moveable component and themotor in response to the measured drag. Compensation may come in theform of moving the moveable component to a new position to maintain thecutting radius defined by the elongated flexible cutting componentdespite the drag on the elongated flexible cutting component.

Cautery Component

In some embodiments, the tissue cutting device includes a cauterycomponent configured to cauterize a tissue during a cutting process. Forexample, as tissue is being cut and/or resected with the elongatedflexible cutting component, a cautery component can be used to stopbleeding and/or destroy tissue at the site of resection. Cauterizationcan be carried out through the use of thermal energy (e.g., heat orcold), electrical current, corrosive chemicals, or focused light (e.g.,laser). In an aspect, cauterization can be carried out usingradiofrequency energy. In an aspect, the cautery component is operablycoupled to the elongated flexible cutting component. For example, theelongated flexible cutting component can carry an electrical current,thermal energy (hot or cold), optical energy, or exude a chemical agent.

In an aspect, the cautery component includes an electrical cauterycomponent. In some embodiments, an electric current is used to heat ametal probe for use in cauterization, i.e., burning or destroyingtissue. In an aspect, an electric current is passed through acurrent-conducting elongated flexible cutting component. For example, atleast a portion of the elongated flexible cutting component can includea wire capable of being electrically heated, e.g., platinum, iron,chromium, and aluminum alloy. In other embodiments, an electric currentis used to directly heat the tissue. For example, the cautery componentcan include application of a high-frequency electrical current directlyto the tissue. See, e.g., Massarweh et al. (2006) J. Am. Coll. Surg.202:520-530, which is incorporated herein by reference.

In an aspect, the cautery component includes an optical cauterycomponent. In an aspect, the optical cautery component includes anoptical fiber including an optical energy sufficient to cauterizetissue. In an aspect, the optical cautery component includes a laserlight source. In an aspect, the laser light is delivered in combinationwith an irrigation fluid to generate a fluid light stream. See, e.g.,U.S. Pat. No. 8,814,921 to Aljuri & Perkins titled “Tissue Ablation andCautery with Optical Energy Carried in Fluid Stream,” which isincorporated herein by reference.

In an aspect, the cautery component includes a thermal cauterycomponent. In an aspect, the thermal cautery component includes a heatcautery component. For example, the elongated flexible cutting componentcan be formed from a material, e.g., platinum, iron, chromium, oraluminum alloys, capable of being heated with an electrical current. Inan aspect, the thermal cautery component includes a cold or cryo cauterycomponent. For example, the tissue cutting component can include asource of a cryogenic agent, e.g., liquid nitrogen, dimethyl etherpropane, or dry ice pellets, for application to the tissue cutting site.

In an aspect, the cautery component includes a chemical cauterycomponent. For example, the cautery component can include one or morechemicals that stop bleeding and/or destroy tissue. Non-limitingexamples includes silver nitrate, trichloroacetic acid, and cantharidin.In an aspect, the chemical cautery component can include a tissueadhesive, e.g., a form of cyanoacrylate. In an aspect, the chemicalcautery component includes one or more cauterizing chemicals releasedfrom an irrigation fluid reservoir. For example, an irrigation fluidreservoir can release silver nitrate to wet the elongated flexiblecutting component during a cutting procedure.

Power Source

In an aspect, the tissue cutting device includes a power source. In anaspect, at least one of the motor and the moveable component is poweredby a power source. In an aspect, the tissue cutting device includes apower source operably coupled to and powering one or more components ofthe tissue cutting device. For example, the tissue cutting device caninclude at least one power source for powering the moveable component,the motor, a computing component, a vacuum source, an irrigation fluidreservoir, at least one analyte sensor, a torque compensation component,a drag compensation component, and/or a cautery component. In an aspect,the power source is incorporated into the tissue cutting device. In anaspect, the power source includes one or more batteries. In an aspect,the one or more batteries include one or more disposable batteries,e.g., cells, buttons, thin-film batteries, or microbatteries. Forexample, at least one of the moveable component and the motor of thetissue cutting device can be powered by a conventional battery, e.g., adisposable 9 volt battery. For example, at least one of the moveablecomponent and the motor and one or more other components of the tissuecutting device can be powered by a conventional battery. Non-limitingexamples of disposable batteries include zinc-carbon, alkaline, lithium,zinc-chloride, zinc-air, or silver-oxide batteries. In an aspect, theone or more batteries include one or more rechargeable batteries. Forexample, at least one of the moveable component and the motor can bepowered by one or more rechargeable lithium-ion batteries. For example,at least one of the moveable component and the motor and one or moreother components of the tissue cutting device can be powered by one ormore rechargeable lithium-ion batteries. Non-limiting examples ofrechargeable batteries include nickel-cadmium, nickel-zinc, nickel metalhydride, silver-zinc, or lithium ion. In an aspect, the power sourceincludes kinetic energy, which may include stored kinetic energy.

In an aspect, the power source for the tissue cutting device includes anelectrical cord accessing power through a common electricaloutput/socket. In an aspect, the power source for the tissue cuttingdevice includes an electrical cord assessing power indirectly through acommon electrical output/socket through connection to another powereddevice (e.g., a desk-top or lap-top computing device) through a USB portor similar type connection.

Handle Casing

In an aspect, the tissue cutting device further includes a handlecasing, the handle casing covering at least a portion the motor, thehandle casing including a user interface. In an aspect, the handlecasing is sized for use with a single hand. In an aspect, the handlecasing further covers one or more other components of the tissue cuttingdevice including at least one of a computing component, an aspirationcomponent, an irrigation component, an image-capture device, at leastone analyte sensor, a torque compensation component, a drag compensationcomponent, a cautery component, or a power source. In an aspect, thehandle casing includes a user interface. In an aspect, the userinterface includes at least one of an on/off switch, buttons, displayscreen, touchscreen, microphone, speakers, and the like for entering andreceiving information.

Tissue Cutting System

Described herein are embodiments of a tissue cutting system including atissue cutting device and a computing component, the tissue cuttingdevice including a central rotatable shaft having a first end and asecond end; a motor operably coupled to the first end of the centralrotatable shaft, the motor including circuitry configured to rotate thecentral rotatable shaft; a moveable component configured to move alongat least a portion of the length of the central rotatable shaft; and anelongated flexible cutting component having a first end and a secondend, the first end of the elongated flexible cutting component securedto the moveable component and the second end of the elongated flexiblecutting component secured to the central rotatable shaft in proximity tothe second end of the central rotatable shaft; wherein movement of themoveable component along the at least a portion of the length of thecentral rotatable shaft changes a shape formed by the elongated flexiblecutting component; and the computing component operably connected to thetissue cutting device, the computing component including a processor andcircuitry.

FIG. 14 illustrates aspects of a tissue cutting system. System 1400includes tissue cutting device 1410 and computing component 1420. Tissuecutting device 1410 includes central rotatable shaft 1430 operablycoupled at one end to motor 1440. Tissue cutting device 1410 furtherincludes elongated flexible cutting component 1460 secured at a firstend to moveable component 1450 and at a second end to central rotatableshaft 1410.

In an aspect, the elongated flexible cutting component of the tissuecutting device is formed from metal. In an aspect, the elongatedflexible cutting component of the tissue cutting device is formed fromat least one polymer. In an aspect, the elongated flexible cuttingcomponent of the tissue cutting device is formed from at least onenatural fiber. In an aspect, the elongated flexible cutting component ofthe tissue cutting device is formed from at least one man-made fiber. Inan aspect, the elongated flexible cutting component of the tissuecutting device is at least one of a flexible wire, strand, string,fiber, thread, or ribbon. In an aspect, the elongated flexible cuttingcomponent of the tissue cutting device includes a circularcross-section. In an aspect, the elongated flexible cutting component ofthe tissue cutting device includes a non-circular cross-section. In anaspect, the elongated flexible cutting component of the tissue cuttingdevice includes at least one cutting edge. In an aspect, the elongatedflexible cutting component of the tissue cutting device includes atleast one serrate edge. In an aspect, the elongated flexible cuttingcomponent of the tissue cutting device is replaceable. In someembodiments, the tissue cutting device includes two or more elongatedflexible cutting components. In an aspect the first ends of the two ormore elongated flexible cutting components are secured to the moveablecomponent and the second ends of the two or more elongated flexiblecutting components are secured to the central rotatable shaft.Additional non-limiting aspects of elongated flexible cutting componentshave been described above herein.

Tissue cutting device 1410 and computing component 1420 are operablyconnected through a communication link 1470. Communication link 1470 caninclude at least one of a wireless communication link (e.g., radio,microwave, optical, sonic, electromagnetic induction communication, orthe like) or a wired communication link (e.g., electrical or fiber opticwire). Tissue cutting device 1410 of system 1400 is shown in the processof cutting tissue 1480, the shape of the resected tissue dictated by theshape formed by the rotating elongated flexible cutting component. In anaspect, computing component 1420 includes circuitry configured tocontrol motor 1440. In an aspect computing component 1420 includescircuitry configured to control rotational frequency of motor 1440. Inan aspect, computing component 1420 includes circuitry configured tocontrol moveable component 1450. In an aspect, computing component 1420includes circuitry configured to control at least one of speed of themoveable component, directionality of the moveable component, and/ordistance traveled by the moveable component. In an aspect, computingcomponent 1420 includes circuitry configured to control movement of themoveable component 1450 in coordination with rotational speed ofelongated flexible cutting component 1460 to generate an asymmetriccutting pattern.

In an aspect, computing component 1420 can take various forms or be partof an object, and can include, but is not limited to, a computer, alaptop computer, a personal electronic device, a dedicated computingdevice, a limited resource computing device, a wireless communicationdevice, a mobile wireless communication device, a handheld electronicwriting device, a tablet, a digital camera, a scanner, a cell phone, aPDA, an electronic tablet device, a printer, or any other like devicethat takes information as an input and gives it back to the end-users.Computing component 1420 can include a digital single processor, ASIC,microprocessor, or other type of processor operating on a system such asa personal computer, server, a router, of other device capable ofprocessing data including network interconnection device. Other aspectsof a computing component have been described above herein.

FIG. 15 illustrates further aspects of a tissue cutting system. System1500 includes tissue cutting device 1510 and computing component 1520.Tissue cutting device 1510 includes central rotatable shaft 1525operably coupled to motor 1530, motor 1530 including circuitryconfigured to rotate central rotatable shaft 1525. Tissue cutting device1510 further includes moveable component 1535 configured to move alongat least a portion of the length of central rotatable shaft 1525.Elongated flexible cutting component 1540 is secured to the moveablecomponent 1535 at a first end and to the central rotatable shaft 1525 ata second end.

In some embodiments, tissue cutting system 1500 includes an aspirationcomponent configured to aspirate tissue debris in proximity to thecentral rotatable shaft 1525 of the tissue cutting device 1510. Theaspiration component includes a vacuum source and an aspirator connectedto the vacuum source. In the non-limiting embodiment shown in FIG. 15,tissue cutting system 1500 includes an external vacuum source 1545(e.g., a vacuum pump or a water aspirator) in fluid communicationthrough a flow conduit 1550 (e.g., surgical tubing) with an aspirator1555 attached to tissue cutting device 1510. In an aspect, at least aportion of the aspiration component is incorporated into the tissuecutting device. In an aspect, the aspirator of the aspiration componentincludes a suction lumen disposed in and defined by the centralrotatable shaft 1525 of the tissue cutting device 1510, the suctionlumen connected to the vacuum source 1545 and in fluid communicationwith one or more openings defined by the central rotatable shaft 1525 ofthe tissue cutting device 1510. In an aspect, the one or more openingsdefined by the central rotatable shaft are positioned along the lengthof the central rotatable shaft. In some embodiments, the entirety of theaspiration component, i.e., the vacuum source and the aspirator, may beincorporated into the tissue cutting device of the tissue cuttingsystem. In an aspect, the aspiration component is operably coupled tocomputing device 1520. In an aspect computing component 1520 includescircuitry configured to control one or more functions (e.g., on/offand/or vacuum pressure) of the aspiration component.

In some embodiments, tissue cutting system 1500 includes an irrigationcomponent configured to irrigate tissue in proximity to the centralrotatable shaft 1525, the irrigation component including a flow conduitattached to an irrigation fluid reservoir. In an aspect, at least aportion of the irrigation component is incorporated into the tissuecutting device 1510. In the non-limiting embodiment shown in FIG. 15,tissue cutting system 1500 includes an external irrigation fluidreservoir 1560 in fluid communication through a flow conduit 1565 (e.g.,surgical tubing) with an irrigation tube 1570 positioned proximal to thecentral rotatable shaft 1525 of the tissue cutting device 1510. In someembodiments, the flow conduit of the irrigation component includes anirrigation lumen disposed in and defined by the central rotatable shaft1525 of the tissue cutting device 1510, the irrigation lumen connectedto the irrigation fluid reservoir 1560 and in fluid communication withone or more openings defined by the central rotatable shaft 1525 of thetissue cutting device 1510. In some embodiments, the entirety of theirrigation component may be incorporated into the tissue cutting deviceof the tissue cutting system. In some embodiments, the entirety of theirrigation component may be a separate entity from the tissue cuttingdevice. For example, the irrigation tube attached to the irrigationfluid reservoir may be physically separated from the tissue cuttingdevice and held by a second hand of a user, e.g., a physician, or asecond practitioner, e.g., a nurse. In an aspect, the irrigationcomponent is operably coupled to computing component 1520. In an aspect,computing component 1520 includes circuitry configured to control one ormore functions of the irrigation component.

In an aspect, the irrigation fluid reservoir 1560 is configured to holdand controllably release at least one irrigation fluid. In an aspect,irrigation fluid reservoir 1560 includes at least one controllable valveto hold and controllably release at least one irrigation fluid. In anaspect, the at least one controllable valve is operably coupled tocomputing component 1520. For example, the controllable valve caninclude a controllable gate, door, port, diaphragm, erodible barrier, orany other type of controllable valve configured to hold and controllablyrelease at least one irrigation fluid from the irrigation fluidreservoir. In an aspect, the at least one irrigation fluid includes atleast one of saline, a buffer, a therapeutic agent, an antimicrobialagent, an anesthetic, or a coagulant agent. Non-limiting aspects ofirrigation fluids have been described above herein.

In some embodiments, tissue cutting system 1500 includes animage-capture device, the image-capture device operably coupled to thecomputing component 1520, the computing component 1520 includingcircuitry configured to receive image data from the image-capturedevice. In an aspect, the received image data includes one or moreimages of a tissue in proximity to the central rotatable shaft of thetissue cutting device. For example, the image-capture device can beconfigured to collect images of a target tissue before, during, and/orafter a cutting procedure to monitor progress and success of theprocedure. In an aspect, the image-capture device includes an opticalimage-capture device. In an aspect, the image-capture device includes anultrasound image-capture device. In an aspect, at least a portion of theimage-capture device is incorporated into tissue cutting device 1510. Inthe non-limiting embodiment shown in FIG. 15, tissue cutting system 1500includes image-capture device 1575 incorporated into tissue cuttingdevice 1510. In other embodiments, the image-capture device may includean external image-capture system, e.g., a digital camera, ultrasound,laparoscopy, or other tissue imaging modality (e.g., magnetic resonance,computed tomography, or fluoroscopy). In an aspect, computing component1520 includes circuitry configured to control at least one of the motor1530 and the moveable component 1535 of the tissue cutting device 1510in response to the received image data. Non-limiting aspects ofimage-capture devices have been described above herein.

In an aspect, the image-capture device includes an energy-emittingcomponent, e.g., a light source or a laser, and circuitry to scan thetissue with directed energy, e.g., light of a specified wavelength, todetect one or more signals emitted from the tissue and to transform theone or more detected signals into a digital output. In an aspect, theone or more signals emitted from the tissue are indicative of propertiesof one or more tissue components, e.g., cells and/or biomolecules.

In an aspect, image-capture device 1575 includes at least one scanningdevice. Non-limiting examples of scanners include optical scanners,fluorescence scanners, acoustic scanners, electrical scanners,electromagnetic scanners, or magnetic scanners. In an aspect, theimage-capture device includes a colorimetric scanner. In an aspect, theimage-capture device includes fluorescence scanning device. In anaspect, the fluorescence scanning device can include fixedexcitation/emission wavelengths based on the use of standardcommercially available fluorescent dyes in the green, red, and nearinfrared wavelengths. For example, the fluorescence scanning device caninclude a two color scanner for scanning at two distinct wavelengths orwavelength bands. In an aspect, the fluorescence scanning device caninclude adjustable excitation/emission wavelengths, e.g., with one ormore excitation sources and filters to adjust the excitation/emissionwavelengths. In an aspect, image-capture device can be configured todetect a fluorescent response at a single wavelength of electromagneticenergy, at two wavelengths of electromagnetic energy, at multiplewavelengths of electromagnetic energy, or over extended-spectrumelectromagnetic energy. In an aspect, the image-capture device can beconfigured to detect excitation energy. In an aspect, the image-capturedevice can be configured to detect a cumulative (optionally fluorescent)response over a time interval. In an aspect, the image-capture devicecan be configured to detect a (optionally fluorescent) response at aspecific time interval and/or at a specific time. In an aspect, theimage-capture device can be configured to detect a time-dependent(optionally fluorescent) response. In illustrative examples, thecumulative response is determined over milliseconds, seconds, and/orminutes following excitation. In an aspect, the response is detectedover millisecond, second, and/or minute time intervals followingexcitation. In an aspect, the response is detected approximatelyfemtoseconds, picoseconds, nanoseconds, milliseconds, seconds, and/orminutes after excitation.

In an aspect, the image-capture device includes components formicro-scanning in which a single CCD sensor with a Bayer filter is movedover the focus plane of the lens to “stitch” together a higherresolution image than the CCD would allow otherwise. In an aspect, themicro-scanning device includes a micro laser scanning device. See, e.g.,Seidl et al. (2006) International Society for Photogrammetry and RemoteSensing. Volume XXXVI Part 5. Sep. 25-27, 2006, Dresden Germany.

In an aspect, the image-capture device includes a three-dimensionalscanning device. Non-limiting examples of three-dimensional scanningdevices include NextEngine 3D Scanner (NextEngine, Inc., Santa Monica,Calif.), Handyscan 3D (Creaform USA Inc., Newark, Del.), or KonicaMinolta 3D scanners (Konica Minolta, Ramsey, N.J.).

In an aspect, the image-capture device includes a confocal laserscanner. In an aspect, the confocal laser scanner can include a handheldconfocal laser scanning microscope (e.g., VIVASCOPE 3000, MAVIG GmbH,Munich, Germany). In an aspect, the confocal laser scanner includes aMEMS confocal laser scanner. See, e.g., Murakami et al. (2003) The12^(th) International Conference on Solid State Sensors, Actuators andMicrosystems, Boston, Jun. 8-12, 2003, pp. 587-590, which isincorporated herein by reference.

In an aspect, the image-capture device includes a light source and adetector for measuring reflected and/or absorbed light. In an aspect,the image-capture device measures changes in refractive index on thesurface of the tissue. Resonance occurs at a specific angle of incidentlight. See, e.g., Barlen, et al. (2007) Sensors, 7:1427-1446; andKashyap & Nemova (2009) J. Sensors: Article ID 645162, which areincorporated herein by reference.

In an aspect, the image-capture device includes a spectrometer orspectrophotometer. In an aspect, the spectrophotometer includes a fiberoptic spectrophotometer (from, e.g., Ocean Optics, Dunedin Fla.). In anaspect, the image-capture device includes a means of vibrationalspectroscopy. Examples of vibrational spectroscopy include, but are notlimited to, Fourier transform infrared (FTIR) spectroscopy andmicro-Raman spectroscopy. Raman spectroscopy can further includeUV-resonance Raman spectroscopy, surface enhanced Raman scattering, ortip-enhanced Raman scattering. See, e.g., Harz et al. (2009) Cytometry A75:104-113, which is incorporated herein by reference.

In an aspect, the image-capture device includes a light source, adigital projector, a CCD camera and a computing device forimage-processing for spatial frequency domain imaging, a wide fieldoptical technique. In an aspect, the image-capture device includes alens-free imaging system. See, e.g., Kim et al. (2012) J. Lab.Automation 17:43-49, which is incorporated herein by reference.

In some embodiments, tissue cutting system 1500 includes at least oneanalyte sensor. In an aspect, the at least one analyte sensor includesat least one of an optical sensor, a magnetic sensor, an electricalsensor, an acoustic sensor, or a chemical sensor. In an aspect, at leasta portion of the at least one analyte sensor is incorporated into thetissue cutting device 1510. In the non-limiting embodiment shown in FIG.15, tissue cutting system 1500 includes at least one analyte sensor 1580incorporated into tissue cutting device 1510. In an aspect, the at leastone analyte sensor may be external to the tissue cutting device. Forexample, the at least one analyte sensor may be positioned in oraccessible from the flow conduit 1550 leading to the external vacuumsource 1545 of tissue cutting system 1500.

In an aspect, the at least one analyte sensor is configured to sense aproperty of one or more analytes in an aspirate. For example, the atleast one analyte sensor can be used to determine whether the aspirate,e.g., tissue debris, contains disease-associated aspirates, e.g.,disease-associated molecules or cells. For example, the at least oneanalyte sensor can be used to determine whether the aspirate containstumor markers or neoplastic cells. In an aspect, the at least oneanalyte sensor is configured to sense an optical property, fluorescenceproperty, magnetic property, electrical property, electromagneticproperty, acoustic property, or chemical property of the one or moreanalytes in the aspirate. In an aspect, the at least one analyte sensoris configured to sense a radioactive property of one or more analytes inthe aspirate. In an aspect, the at least one analyte sensor is operablycoupled to the computing component 1520, the computing component 1520including circuitry configured to receive sensor input from the at leastone analyte sensor and to control at least one of the motor 1530 and themoveable component 1535 in response to the received sensor input.Non-limiting examples of analyte sensors have been described aboveherein.

In some embodiments, tissue cutting system 1500 includes a torquecompensation component 1585. In an aspect, the torque compensationcomponent is configured to prevent oscillation. In an aspect, the torquecompensation component is configured to prevent oscillation whilegenerating asymmetric cutting patterns. For example, the torquecompensation component can be configured to prevent oscillation of thetissue cutting device when the cutting radius of the elongated flexiblecutting component changes during the course of a single rotation togenerate an asymmetric cutting pattern. In an aspect, the torquecompensation component includes at least one counterweight. For example,the torque compensation component can include at least one counterweightassociated with the central rotatable shaft 1525 of tissue cuttingdevice 1510. In an aspect, the at least one counterweight moves, e.g.,pivots, in response to changes in the shape formed by the elongatedflexible cutting component 1540. For example, the at least onecounterweight can pivot back and forth around a pivot point tocounterbalance the changing shape formed by the elongated flexiblecutting component 1540 as the moveable component 1535 moves up and downat least a portion of the length of the central rotatable shaft 1525 ofthe tissue cutting device 1510. A non-limiting example of a pivotingcounterweight is illustrated in FIGS. 10A-C.

In an aspect, torque compensation component 1585 includes at least onecounterweight that is extendible. In an aspect, the at least onecounterweight extends and retracts in response to changes in the shapeformed by the elongated flexible cutting component. For example, the atleast one counterweight can extend and retract along a slide groove andaround a pivot point to counterbalance the changing shape formed by theelongated flexible cutting component 1540 as the moveable component 1535moves up and down at least a portion of the length of the centralrotatable shaft 1525 of the tissue cutting device 1510. A non-limitingexample of an extendable counterweight is illustrated in FIGS. 11A-C.

In an aspect, torque compensation component 1585 includes circuitry andmotors configured to control the position of the at least onecounterweight. In an aspect, torque compensation component 1585 isoperably coupled to computing component 1520, the computing componentincluding circuitry configured to control the torque compensationcomponent. For example, computing component 1520 can include circuitryconfigured to control a position of at least one counterweight.

In some embodiments, tissue cutting system 1500 includes a dragcompensation component 1590. For example, the drag compensationcomponent can include a spar and one or more stays to stabilize theelongated flexible cutting component during rotation, a non-limitingexample of which is shown in FIGS. 12A and 12B. In an aspect, dragcompensation component 1590 is configured to measure drag from theelongated flexible cutting component 1540 of tissue cutting device 1510during rotation. For example, the drag compensation component canincludes a transceiver and at least one reflector to measuredisplacement of the elongated flexible cutting component duringrotation, a non-limiting example of which is shown in FIGS. 13A-C anddescribed above herein. In an aspect, drag compensation component 1590is operably coupled to computing component 1520. In an aspect, computingcomponent 1590 includes circuitry configured to control at least one ofthe moveable component and the motor in response to the measured drag.For example, the computing component can include circuitry configured tochange the position of the moveable component and consequently the shapeformed by the elongated flexible cutting component to compensate for themeasured drag.

In some embodiments, tissue cutting system 1500 includes a cauterycomponent 1595 configured to cauterize tissue during a cutting process.In an aspect, the cautery component 1595 is operably coupled to theelongated flexible cutting component 1540. For example, the elongatedflexible cutting component can be configured with at least a portion ofthe cautery component to cauterize tissue during a cutting procedure. Inan aspect, the cautery component includes an electrical cauterycomponent. In an aspect, the cautery component includes an opticalcautery component. In an aspect, the cautery component includes athermal cautery component. In an aspect, the cautery component includesa chemical cautery component. Non-limiting aspects of cautery componentshave been described above herein. In an aspect, at least a portion ofthe cautery component is incorporated into the tissue cutting device.

Tissue Cutting Device Including a Tethering Component and at Least OneTether

Described herein is a tissue cutting device including a tetheringcomponent; an elongated flexible cutting component having a first endand a second end, the first end and the second end of the elongatedflexible cutting component secured to the tethering component; at leastone tether having a first end and a second end, the first end of the atleast one tether attached to the elongated flexible cutting component ata position between the first end and the second end of the elongatedflexible cutting component, the second end of the at least one tetheroperably coupled to the tethering component, the tethering componentincluding circuitry configured to extend and retract the at least onetether; and a motor operably coupled to the tethering component, themotor including circuitry configured to rotate the tethering componentand the secured elongated flexible cutting component; wherein extensionand refraction of the at least one tether by the tethering componentchanges a shape formed by the elongated flexible cutting component.

FIG. 16 illustrates aspects of a tissue cutting device including atethering component. Tissue cutting device 1600 includes tetheringcomponent 1610. Tissue cutting device 1600 further includes elongatedflexible cutting component 1620. A first end 1622 of elongated flexiblecutting component 1620 and a second end 1624 of elongated flexiblecutting component 1620 are secured to tethering component 1610. Tissuecutting device 1600 further includes at least one tether 1630 includinga first end 1632 and a second end 1634. The first end 1632 of the atleast one tether 1630 is attached to elongated flexible cuttingcomponent 1620 at a position between the first end 1622 and the secondend 1624 of elongated flexible cutting component 1620. The second end1634 of the at least one tether 1630 is operably coupled to tetheringcomponent 1610. Tissue cutting device 1600 further includes motor 1640operably coupled to tethering component 1610, motor 1640 includingcircuitry configured to rotate tethering component 1610. Elongation andretraction of the at least one tether 1630 by the tethering componentchanges a shape formed by the elongated flexible cutting component 1620.For example, retracting the at least one tether causes the elongatedflexible cutting component to take a wider and shorter shape. Forexample, extending the at least one tether causes the elongated flexiblecutting component to take a narrower and longer shape.

In an aspect, the elongated flexible cutting component 1620 forms a loopwhen attached at the first and the second end to the tetheringcomponent. In an aspect, extension or retraction of the at least onetether by the tethering component changes the shape of the loop formedby the elongated flexible cutting component. For example, the loop canbe shortened and widened as the at least one tether is retracted by thetethering component. For example, the loop can be lengthened andnarrowed as the at least one tether is extended by the tetheringcomponent. Rotation of the tethering component and the attachedelongated flexible cutting component by the motor causes the elongatedflexible cutting component to form a cutting pattern.

In an aspect, the shape formed by the elongated flexible cuttingcomponent is fixed. For example, the at least one tether can bepositioned and locked into place prior to a cutting procedure, the shapeformed by the elongated flexible cutting component remaining constantand creating a symmetrical cutting pattern as it rotates with therotating tethering component.

In an aspect, the shape formed by the elongated flexible cuttingcomponent varies through the course of a cutting procedure. For example,the shape of the rotating elongated flexible cutting component can varyas the tissue cutting device is moved into the tissue, with a smallcutting radius at the point of entering the tissue and a larger cuttingradius once the target tissue for resection has been reached.

FIGS. 17A and 17B illustrate changes in the shape formed by theelongated flexible cutting component as well as the tissue cuttingpattern in response to retraction of the tether by the tetheringcomponent. FIG. 17A shows tissue cutting device 1600 at a first timepoint relative to tissue 1700. Tissue cutting device 1600 includestethering component 1610, elongated flexible cutting component 1620,tether 1630, and motor 1640. Tissue cutting device 1600 is shown cuttinginto tissue 1700 and target tissue mass 1710. Tether 1630 and elongatedflexible cutting component 1620 are in a first position that createsresected space 1720 as tethering component 1610 and attached elongatedflexible cutting component 1630 are rotated by motor 1640. As theelongated flexible cutting component 1620 rotates, it cuts away attissue 1700 in a pattern dependent upon the shape formed by theelongated flexible cutting component 1620. FIG. 17B shows tissue cuttingdevice 1600 at a second time point relative to tissue 1700. At thispoint, elongated flexible cutting component 1620 and tether 1630 areshown further into tissue 1700. Tether 1630 and elongated flexiblecutting component 1620 are in a second position that creates resectedspace 1730 as tethering component 1610 and attached elongated flexiblecutting component 1620 are rotated by motor 1640. In this example,tissue mass 1710 has been removed, leaving resected space 1730.

In an aspect, tissue cutting device 1600 such as described herein isused for minimally invasive surgery to cut and resect tissue. In anaspect, the tissue cutting device is inserted into a tissue of apatient. In some embodiments, the distal portion of the tissue cuttingdevice (e.g., the first end of a rigid tether attached to the elongatedflexible cutting component) is adapted to pierce tissue. In otherembodiments, the tissue cutting device is inserted into a previouslyestablished surgical incision (e.g., a 0.5 cm to 2 cm incision). In anaspect, the tissue cutting device is inserted into a body lumen (e.g., ablood vessel, gastrointestinal tract, vagina, rectum, airway, ureter, orurethra).

A tissue cutting device such as described herein can enter tissue by anyof a number of routes including, but not limited to, transabdominal,transperineal, transcutaneous, transvascular, transurethral,transureteral, transoral, transvaginal, and transrectal routes ofinsertion. A wide range of tissue can be cut and resected including butnot limited to prostatic tissue, kidney tissue, liver tissue, uterinetissue, bladder tissue, and brain tissue. In an aspect, the tissue to becut and resected is benign tissue (e.g., fibrotic tissue in uterus orprostate). In an aspect, the tissue to be cut and resected is malignanttissue (e.g., a solid tumor).

In an aspect, the tissue cutting device is sized for placement intocannula or trocar. For example, the elongated flexible cutting componentand the at least one tether of the tissue cutting device may be extendedfrom or retracted into a cannula or trocar configured for performingminimally invasive surgery.

Tissue cutting device 1600 includes elongated flexible cutting component1620. In an aspect, the elongated flexible cutting component is formedfrom metal. For example, the elongated flexible cutting componentincludes a wire formed from stainless steel. In an aspect, the elongatedflexible cutting component is formed from at least one polymer. Forexample, the elongated flexible cutting component can be a ribbon formedfrom nylon or polyethylene. In an aspect, the elongated flexible cuttingcomponent is formed from at least one natural fiber. For example, theelongated flexible cutting component can be formed from silk. In anaspect, the elongated flexible cutting component is formed from at leastone man-made fiber. For example, the elongated flexible cuttingcomponent can be formed from carbon fiber. In an aspect, the elongatedflexible cutting component includes at least one of a flexible wire,strand, string, fiber, thread, or ribbon. In an aspect, the elongatedflexible cutting component includes a circular cross-section. In anaspect, the elongated flexible cutting component includes a non-circularcross-section (e.g., a polygon with three or more sides). In an aspect,the elongated flexible cutting component includes at least one cuttingedge. In an aspect, the elongated flexible cutting component includes atleast one serrated edge. In an aspect, the elongated flexible cuttingcomponent is replaceable. Other non-limiting aspects of an elongatedflexible cutting component have been described above herein.

In an aspect, tissue cutting device 1600 further includes two or moreelongated flexible cutting components. In an aspect, a first end and asecond end of each of the two or more elongated flexible cuttingcomponents is attached to the tethering component. In an aspect, each ofthe two or more elongated flexible cutting components is attached to atleast one tether. In an aspect, each of the at least one tether attachedto each of the two or more elongated flexible cutting components extendsand retracts independently. In an aspect, each of the at least onetether attached to each of the two or more elongated flexible cuttingcomponents extends and retracts simultaneously.

Tethering Component

Tissue cutting device 1600 includes a tethering component 1610configured to extend and retract the at least one tether. In an aspect,the tethering component includes a manual tethering component. Forexample, the tethering component can include a fastening device forholding the at least one tether at a specific length. For example, thefastening device can include a clamping device, a holding device, aclinching device, a cinching device, an anchoring device, a hitchingdevice, or a securing device. For example, the fastening device caninclude a clamp, a snap, a screw, or a pin. For example, the tetheringcomponent can include a “pull-through” function in which the at leastone tether (e.g., a wire, string, chain, or ribbon) is pulled through aclosable fastening device until the appropriate length is reached andthe closable fastening device is closed.

In an aspect, the tethering component includes a locking componentconfigured to hold the at least one tether at a specific length. Forexample, the tethering component can include a lockable clamp. Forexample, the tethering component can include at least one lockable gearwith a gripping surface (e.g., teeth, abrasive, or adhesive) designed tointeract with the at least one tether and prevent slippage. For example,the tethering component can include a hinged or pivoted device, e.g., apawl, adapted to fit into a notch of a ratchet wheel to impart extensionand/or retraction or to prevent extension and/or refraction.

In some embodiments, the tethering component includes circuitryconfigured to extend and retract the at least one tether. For example,the tethering component can include a ratchet or gears configured tocontrollably extend and/or retract the at least one tether. For example,the tethering component can include a motorized ratchet or gearsconfigured to controllably extend and/or retract the at least onetether. In an aspect, the tethering component includes circuitryconfigured to either extend or retract the tethering component. Forexample, the tethering component can include a locking component and aretraction component, the at least one tether extended by centrifugalforce of rotation, locked after sufficient extension, and refracted bythe retraction component. In an aspect, the tethering component includesat least one rotatable component, the second end of the at least onetether secured to the at least one rotatable component, the at least onerotatable component configured to extend and retract the secured atleast one tether. For example, the tethering component can include arotatable gear to which at least one tether is secured and a secondmotor including circuitry configured to rotate the rotatable gear toextend and retract the attached tether. For example, the tetheringcomponent can include one or more rotatable gears configured to generatereciprocating motion to extend and/or retract a rigid tether (e.g., arod).

Tethering component 1610 is operably coupled to motor 1640. Motor 1640includes circuitry configured to rotate tethering component 1610 and thesecured elongated flexible cutting component 1620. In an aspect, thetethering component is attached to a rotating shaft of the motor. In anaspect, the motor is a rotary shaft motor, such as a conventional DC,pulse, or AC motor. In an aspect, the motor can include a brush DCmotor. In an aspect, the motor can include a DC servo. In an aspect, themotor can include a rotary piezoelectric motor. Other non-limitingexamples of motors for use in rotating the central rotatable shaftinclude a stepper control motor, a brushless DC commutated controlmotor, or a universal motor. In general, motors for use in smallelectronics or hand-held devices are known in the art and available fromcommercial sources.

Tether

Tissue cutting device 1600 includes at least one tether 1630 having afirst end and a second end, the first end of the at least one tetherattached to the elongated flexible cutting component 1620 at a positionbetween the first end and the second end of the elongated flexiblecutting component 1620, the second end of the at least one tetheroperably coupled to the tethering component 1610, the tetheringcomponent 1610 configured to extend and retract the at least one tether1630. In an aspect, the at least one tether includes at least oneflexible tether. For example, the at least one tether can include a wirethat is attached at one end to the elongated flexible cutting componentand at the other end to the tethering component. In an aspect, the atleast one tether includes at least one rigid tether. For example, the atleast one tether can include a rigid rod that is attached at one end tothe elongated flexible cutting component and at the other end to thetethering component. In an aspect, the at least one tether is formedfrom metal. For example, the at least one tether can be formed fromplatinum, silver, iron, copper, aluminum, or gold. For example, the atleast one tether can be formed from a metal alloy, e.g., stainlesssteel, brass, or bonze. In an aspect, the at least one tether is formedfrom at least one polymer. For example, the at least one tether can beformed from a plastic polymer. In an aspect, the at least one tether isformed from at least one of natural fiber and man-made fiber. In anaspect, the at least one tether is formed from natural fiber. Forexample, the at least one tether can be formed from vegetable fiber,e.g., cotton, hemp, jute, flax, ramie, sisal, or bagasse. For example,the at least one tether can be formed from wood fiber. For example, theat least one tether can be formed from animal fibers, e.g., silkwormsilk, spider silk, sinew, catgut, wool, sea silk, or hair. For example,the at least one tether can be formed from mineral fibers, e.g.,asbestos. In an aspect, the at least one tether is formed from man-madefiber. For example, the at least one tether can be formed fromregenerated fibers, e.g., cellulose from wood pulp. For example, the atleast one tether can be formed from semi-synthetic fibers, e.g., nylon(polyamide), Dacron (polyester), and rayon. For example, the at leastone tether can be formed from synthetic fibers, e.g., metallic fibers,carbon fiber, silicon carbide fiber, fiberglass, mineral fibers, polymerfibers, and microfibers. In an aspect, the at least one tether is formedfrom polymer fibers, non-limiting examples of which include polyamidenylon, PET or PBT polyester, phenol-formaldehyde, polyvinyl chloridefiber, polyolefin fibers, acrylic polyesters, aromatic polyamids,polyethylene, elastomers, polyurethane fiber, elastolefin. In an aspect,the at least one tether is at least one of a wire, strand, string,fiber, ribbon, or rod. In an aspect, the at least one tether isreplaceable.

In an aspect, the at least one tether is attached equidistance from thefirst and second ends of the elongated flexible cutting component. In anaspect, the at least one tether is attached closer to either the firstor the second end of the elongated flexible cutting component. In anaspect, the at least one tether is attached to the elongated flexiblecutting component so as to form a symmetrical cutting pattern, e.g., anoval cutting pattern. In an aspect, the at least one tether is attachedto the elongated flexible cutting component so as to form anasymmetrical cutting pattern. In an aspect, extension and retraction ofthe at least one tether during the course of a single rotation of theelongated flexible cutting component creates an asymmetrical cuttingpattern.

In an aspect, the at least one tether includes two or more first endsand one second end. For example, the at least one tether can include aY-shape. In an aspect, each of the two or more first ends of the atleast one tether are attached to the elongated flexible cuttingcomponent at a position between the first end and the second end of theelongated flexible cutting component. In an aspect, the second end ofthe at least one tether is operably coupled to the tethering component.

In an aspect, the at least one tether includes at least one first endattached to the elongated flexible cutting component and at least onesecond end operably coupled to the tethering component. For example, theat least one tether can include an X-shape, wherein two of the ends areattached to the elongated flexible cutting component and the remainingtwo ends are operably coupled to the tethering component. In an aspect,each of the ends of the at least one tether operably coupled to thetethering component are configured to be independently extended andretracted by the tethering component. In an aspect, each of the ends ofthe at least one tether operably coupled to the tethering component areconfigured to be simultaneously extended and retracted by the tetheringcomponent.

In some embodiments, a tissue cutting device includes two or moretethers attached at one end to an elongated flexible cutting componentand at a second end to a tethering component. FIGS. 18A-C illustrateaspects of a tissue cutting device including two tethers. FIG. 18A showstissue cutting device 1800 including tethering component 1810, elongatedflexible cutting component 1820, and motor 1850. Elongated flexiblecutting component 1820 is attached at a first end 1822 and at a secondend 1824 to tethering component 1810. Tissue cutting device 1800 furtherincludes a first tether 1830 and a second tether 1840. First tether 1830is attached at a first end 1832 to elongated flexible cutting component1820. A second end 1834 of first tether 1830 is operably coupled totethering component 1810. Second tether 1840 is attached at a first end1842 to elongated flexible cutting component 1820. A second end 1844 ofsecond tether 1840 is operably coupled to tethering component 1810.Elongated flexible cutting component 1820 is shown in a slack positionin the absence of rotation.

In some embodiments, a first tether and a second tether attached to anelongated flexible cutting component are retracted simultaneously by atethering component, as illustrated in FIG. 18B. Tissue cutting device1840 is shown with motor 1850 rotating tethering component 1810 andattached elongated flexible cutting component 1820, first tether 1830,and second tether 1840. As elongated flexible cutting component 1820rotates, the slack portion swings out in response to outward centrifugalforces (arrows 1860). First tether 1830 and second tether 1840 are shownat the same retracted state, causing the elongated flexible cuttingcomponent 1820 to form a symmetrical shape.

In some embodiments, a first tether and a second tether attached to anelongated flexible cutting component are retracted asymmetrically by atethering component, as illustrated in FIG. 18C. Tissue cutting device1800 is shown with motor 1850 rotating tethering component 1810 andattached elongated flexible cutting component 1820, first tether 1830,and second tether 1840. In this non-limiting example, tetheringcomponent 1810 has asymmetrically retracted first tether 1830 along apath illustrated by arrow 1870 relative to second tether 1840, causingelongated flexible cutting component 1820 to form an asymmetrical shape.

In an aspect, the shape formed by the elongated flexible cuttingcomponent and the at least one tether is set and locked prior toinitiating the cutting procedure. In an aspect, the shape formed by theelongated flexible cutting component and the at least one tether ischanged during the course of the cutting procedure. For example, thetethering component can extend and/or retract the at least one tetherduring the course of the resection procedure to alter the cuttingpattern formed by the elongated flexible cutting component. In anaspect, the shape formed by the elongated flexible cutting component andthe at least one tether is changed during the course of a singlerotation of the tethering component. For example, the tetheringcomponent can extend and/or retract the at least one tether during asingle rotation of the tethering component and the attached elongatedflexible cutting component to alter the cutting pattern formed by theelongated flexible cutting component.

FIG. 19 illustrates further aspects of a tissue cutting device such asshown in FIG. 16. In an aspect, tissue cutting device 1900 includestethering component 1910, elongated flexible cutting component 1920,tether 1930, and motor 1940. In this non-limiting examples, tetheringcomponent 1910 includes at least one rotatable component 1912, thesecond end of tether 1930 secured to the at least one rotatablecomponent 1912, the at least one rotatable component 1912 configured toat least one of extend and retract the at least one tether 1930. Forexample, the at least one rotatable component 1912 can be configured toextend and/or retract the at least one tether 1930.

Tissue cutting device 1900 further includes computing component 1950. Inan aspect, computing component 1950 includes a processor and circuitry.In an aspect, computing component 1950 is operably coupled to at leastone of tethering component 1910 and motor 1940. In an aspect, computingcomponent 1950 includes circuitry configured to control tetheringcomponent 1910. In an aspect, computing component 1950 includescircuitry configured to control at least one of extension and retractionof the at least one tether 1930 by tethering component 1910. In anaspect, computing component 1950 includes circuitry configured tocontrol at least one of speed and length of extension of the at leastone tether 1930 by the tethering component 1910. In an aspect, computingcomponent 1950 includes circuitry configured to control at least one ofspeed and length of retraction of the at least one tether 1930 bytethering component 1910. For example, the computing component caninclude circuitry configured to control at least one of speed, distancetraveled, and directionality of the tethering component. In an aspect,computing component 1950 includes circuitry configured to control motor1940. In an aspect, computing component 1950 includes circuitryconfigured to control rotational frequency of the motor 1940. Forexample, the computing component can include circuitry configured tocontrol rotational frequency of the tethering component operably coupledto the motor. Non-limiting aspects of a computing component have beendescribed above herein.

In an aspect, tissue cutting device 1900 includes an aspirationcomponent configured to aspirate tissue debris in proximity to theelongated flexible cutting component. The aspiration component furtherincludes a vacuum source and an aspirator connected to the vacuumsource. FIG. 19 illustrates a non-limiting example of a tissue cuttingdevice including an aspiration component. Tissue cutting device 1900includes vacuum source 1960 and an aspirator 1965 connected to thevacuum source. In an aspect, the aspirator includes a suction tubepositioned proximal to the elongated flexible cutting component, thesuction tube connected to the vacuum source. In an aspect, the aspiratorincludes a suction tube positioned outside a cutting radius of theelongated flexible cutting component, the suction tube connected to thevacuum tube. In an aspect, the aspirator includes a suction tubepositioned inside a cutting radius of the elongated flexible cuttingcomponent. For example, the suction tube can be positioned parallel tothe length of the at least one tether. For example, the aspirator caninclude a suction lumen disposed in and defined by a rigid tether, e.g.,a suction lumen defined by a rod.

In an aspect, tissue cutting device 1900 includes an irrigationcomponent configured to irrigate tissue in proximity to the elongatedflexible cutting component. The irrigation component further includes aflow conduit attached to an irrigation reservoir. FIG. 19 illustrates anon-limiting example of a tissue cutting device including an irrigationcomponent. Tissue cutting device 1900 includes irrigation fluidreservoir 1970 and fluid conduit 1975. In an aspect, the flow conduitincludes an irrigation tube positioned proximal to the elongatedflexible cutting component, the irrigation tube connected to theirrigation fluid reservoir. In an aspect, the flow conduit includes anirrigation tube positioned outside of a cutting radius of the elongatedflexible cutting component, the irrigation tube connected to theirrigation fluid reservoir. In an aspect, the flow conduit includes anirrigation tube positioned inside of a cutting radius of the elongatedflexible cutting component, the irrigation tube connected to theirrigation fluid reservoir. For example, the irrigation tube can bepositioned parallel to the length of the at least one tether. Forexample, the flow conduit can include an irrigation lumen disposed inand defined by a rigid tether, e.g., an irrigation lumen defined by arod.

In an aspect, irrigation fluid reservoir 1970 is configured to hold andcontrollably release at least one irrigation fluid. In an aspect,irrigation fluid reservoir 1970 includes at least one controllablevalve, the at least one controllable valve operably coupled to acomputing component, e.g., computing component 1950. For example, thecontrollable valve can include a controllable gate, door, port,diaphragm, erodible barrier, or any other type of controllable valveconfigured to hold and controllably release at least one irrigationfluid from the irrigation fluid reservoir. In an aspect, the at leastone irrigation fluid includes at least one of saline, a buffer, atherapeutic agent, an antimicrobial agent, an anesthetic, or a coagulantagent. Non-limiting examples of irrigation fluid components have beendescribed above herein.

In an aspect, tissue cutting device 1900 further includes power source1980. In an aspect, power source 1980 includes an electrical connection,e.g., a wired connection, to a conventional electrical outlet. In anaspect, power source 1980 includes one or more batteries.

FIG. 20 illustrates further aspects of a tissue cutting device such asshown in FIG. 20. Tissue cutting device 2000 includes tetheringcomponent 2005, elongated flexible cutting component 2010, at least onetether 2015, and motor 2020. Tissue cutting device 2000 further includescomputing component 2025 including a processor and circuitry. Tissuecutting device 2000 further includes power source 2080. For example,tissue cutting device 2000 can include an electrical cord for use withan electrical outlet. For example, tissue cutting device 2000 caninclude one or more batteries. In some embodiments, tissue cuttingdevice 2000 includes an aspiration component including vacuum source2035 and aspirator 2040. In some embodiments, tissue cutting device 2000includes an irrigation component including an irrigation fluid reservoir2045 and a flow conduit 2050. In some embodiments, tissue cutting device2000 includes both an aspiration component and an irrigation component.

In some embodiments, tissue cutting device 2000 includes image-capturedevice 2055. The image-capture device 2055 is operably coupled to acomputing component 2025, the computing component 2025 includingcircuitry configured to receive image data from image-capture device2055. In an aspect, image-capture device 2055 includes an opticalimage-capture device. For example, image-capture device 2055 can includea digital camera, a fluoroscope, or a laparoscope. In an aspect,image-capture device 2055 includes an ultrasound image-capture device.

In some embodiments, tissue cutting device 2000 includes at least oneanalyte sensor 2060. The at least one analyte sensor is configured tosense a property of one or more analytes in an aspirate. In an aspect,the at least one analyte sensor includes at least one of an opticalsensor, a magnetic sensor, an electrical sensor, an acoustic sensor, ora chemical sensor. In an aspect, the at least one analyte sensor isconfigured to sense an optical property, fluorescence property, magneticproperty, electrical property, electromagnetic property, acousticproperty, or chemical property of the one or more analytes in theaspirate. In an aspect, the at least one analyte sensor is configured tosense in situ a property of the target tissue before, during, and/orafter the resection procedure. For example, the at least one analytesensor can be configured to sense in situ an optical property, afluorescence property, a magnetic property, an electrical property,electromagnetic property, acoustic property, or chemical property of thetarget tissue before, during, and/or after the resection procedure.Non-limiting aspects of analyte sensors have been described aboveherein.

In some embodiments, tissue cutting device 2000 includes dragcompensation component 2065. For example, the drag compensationcomponent can include at least one spar and one or more stays such asdescribed in FIGS. 12A and 12B. In an aspect, the drag compensationcomponent includes circuitry configured to measure drag from theelongated flexible cutting component during rotation. For example, thedrag compensation component can include a transceiver and at least onereflector, such as described in FIGS. 13A-C. In an aspect, the dragcompensation component 2065 is operably coupled to a computing component2025, the computing component 2025 including circuitry configured tocontrol at least one of the tethering component and the motor inresponse to the measured drag.

In an aspect, embodiments, tissue cutting device 2000 includes torquecompensation component 2070. In an aspect, the torque compensationcomponent includes circuitry configured to prevent oscillation. Forexample, the torque compensation component can include circuitryconfigured to prevent oscillation during an asymmetric cuttingprocedure. In an aspect, the torque compensation component includes atleast one counterweight. For example, the torque compensation componentcan include at least one pivoting counterweight associated with thetissue cutting device. In an aspect, the torque compensation componentincludes at least one counterweight that is extendable. In an aspect,torque compensation component 2070 is operably coupled to computingcomponent 2025, computing component 2025 including circuitry configuredto control the torque compensation component 2070. For example,computing component 2025 can includes circuitry to control movement ofthe at least one counterweight.

In some embodiments, tissue cutting device 2000 includes cauterycomponent 2075. In an aspect, the cautery component is configured tocauterize tissue during a cutting process. In an aspect, the cauterycomponent is operably coupled to the elongated flexible cuttingcomponent. For example, the elongated flexible cutting component can beelectrified and/or heated to cauterize while cutting. In an aspect, thecautery component includes at least one of an electrical cauterycomponent, an optical cautery component, a thermal cautery component, ora chemical cautery component.

In an aspect, tissue cutting device 2000 further includes a handlecasing 2085, the handle casing covering at least a portion of thetethering component and the motor, the handle casing including a userinterface. In an aspect, the handle casing is sized for use with asingle hand. In an aspect, the handle casing further covers one or moreother components of the tissue cutting device (e.g., the tetheringcomponent, a computing component, an aspiration component, an irrigationcomponent, an image-capture device, at least one analyte sensor, atorque compensation component, a drag compensation component, a cauterycomponent, or a power source). In an aspect, the handle casing includesa user interface. In an aspect, the user interface includes at least oneof an on/off switch, buttons, display screen, touchscreen, microphone,speakers, and the like for entering and receiving information.

Tissue Cutting System Including a Tissue Cutting Device and a ComputingComponent

Described herein is a tissue cutting system including a tissue cuttingdevice including a tethering component; an elongated flexible cuttingcomponent having a first end and a second end, the first end and thesecond end of the elongated flexible cutting component secured to thetethering component; at least one tether having a first end and a secondend, the first end of the at least one tether attached to the elongatedflexible cutting component at a position between the first end and thesecond end of the elongated flexible cutting component, the second endof the at least one tether operably coupled to the tethering component,the tethering component configured to at least one of extend and retractthe at least one tether; and a motor operably coupled to the tetheringcomponent, the motor including circuitry configured to rotate thetethering component and the secured elongated flexible cuttingcomponent; and a computing component operably coupled to the tissuecutting device, the computing component including a processor andcircuitry.

FIG. 21 illustrates aspects of a tissue cutting system. System 2100includes tissue cutting device 2110 and computing component 2120. Tissuecutting device 2110 includes a tethering component 2130; an elongatedflexible cutting component 2140 having a first end and a second end, thefirst end and the second end of the elongated flexible cutting component2140 secured to tethering component 2130; at least one tether 2150having a first end and a second end, the first end of the tether 2150attached to the elongated flexible cutting component 2140 at a positionbetween the first end and the second end of the elongated flexiblecutting component 2140, the second end of the tether 2150 operablycoupled to the tethering component 2130, the tethering component 2130including circuitry configured to extend and retract that at least onetether 2150; and a motor 2160 operably coupled to the tetheringcomponent 2130, motor 2160 including circuitry configured to rotate thetethering component 2130. System 2100 includes computing component 2120operably coupled to tissue cutting device 2110, computing component 2120including a processor and circuitry.

Tissue cutting device 2110 of tissue cutting system 2100 includestethering component 2130. In an aspect, the tethering component includescircuitry configured to at least one of extend and retract the at leastone tether. In an aspect, the tethering component of the tissue cuttingdevice includes at least one rotatable component, e.g., a gear orpulley, the second end of the at least one tether of the tissue cuttingdevice secured to the at least one rotatable component, the at least onerotatable component configured to extend and retract the at least onetether. In an aspect, the tethering component includes at least oneclamp, the second end of the at least one tether passing through the atleast one clamp. In an aspect, extension and retraction of the at leastone tether by the tethering component changes a shape formed by theelongated flexible cutting component.

Tissue cutting device 2110 of tissue cutting system 2100 includeselongated flexible cutting component 2140. In an aspect, the elongatedflexible cutting component of the tissue cutting device is formed frommetal. In an aspect, the elongated flexible cutting component of thetissue cutting device is formed from at least one polymer. In an aspect,the elongated flexible cutting component of the tissue cutting device isformed from at least one natural fiber. In an aspect, the elongatedflexible cutting component of the tissue cutting device is formed fromat least one man-made fiber. In an aspect, the elongated flexiblecutting component of the tissue cutting device is at least one of aflexible wire, strand, string, fiber, thread, or ribbon. In an aspect,the elongated flexible cutting component of the tissue cutting deviceincludes a circular cross-section. In an aspect, the elongated flexiblecutting component of the tissue cutting device includes a non-circularcross-section. In an aspect, the elongated flexible cutting component ofthe tissue cutting device includes at least one cutting edge. In anaspect, the elongated flexible cutting component of the tissue cuttingdevice includes at least one serrated edge. In an aspect, the elongatedflexible cutting component is replaceable.

In some embodiments, the tissue cutting device 2110 includes two or moreelongated flexible cutting components. In an aspect, a first end and asecond end of each of the two or more elongated flexible cuttingcomponents is attached to the tethering component 2130. In an aspect,each of the two or more elongated flexible cutting components isattached to at least one tether.

Tissue cutting device 2110 of tissue cutting system 2100 includes atleast one tether 2150. In an aspect, the at least one tether of thetissue cutting device includes at least one flexible tether. Forexample, the at least one tether can include a wire or ribbon that iscapable of being wound up and down by the tethering component. In anaspect, the at least one tether of the tissue cutting device includes atleast one rigid tether. For example, that at least one tether caninclude a rod formed from metal or plastic that is capable of beingpushed up and down by the tethering component. In an aspect, the atleast one tether of the tissue cutting device is formed from metal,e.g., stainless steel or titanium. In an aspect, the at least one tetherof the tissue cutting device is formed from at least one polymer, e.g.,nylon or polyethylene. In an aspect, the at least one tether of thetissue cutting device is at least one of a wire, strand, string, fiber,thread, ribbon, or rod. In an aspect, the at least one tether of thetissue cutting device is replaceable.

In an aspect, the at least one tether of the tissue cutting deviceincludes two or more first ends and one second end, each of the two ormore first ends of the at least one tether attached to the elongatedflexible cutting component at a position between the first and thesecond end of the elongated flexible cutting component, the second endof the at least one tether operably coupled to the tethering component.For example, the at least one tether can include a Y-shape. In anaspect, the at least one tether of the tissue cutting device includes atleast one first end attached to the elongated flexible cutting componentand at least one second end operably coupled to the tethering component.For example, the at least one tether can include an X-shape.

Tissue cutting device 2110 and computing component 2120 of tissuecutting system 2100 are operably connected through a communication link2170. Communication link 2170 can include at least one of a wirelesscommunication link, e.g., a radio transmission link, or a wiredcommunication link, e.g., an electrical link. Tissue cutting device 2110of system 2100 is shown in the process of cutting tissue 2180, the shapeof the resected tissue dictated by the shape formed by the rotatingelongated flexible cutting component.

In an aspect, computing component 2120 includes circuitry configured tocontrol the tethering component 2130. For example, computing component2120 can include circuitry configured to control at least one ofextension and/or retraction of the at least one tether by the tetheringcomponent. In an aspect, the computing component includes circuitryconfigured to control at least one of speed and length of extension ofthe at least one tether by the tethering component. In an aspect, thecomputing component includes circuitry configured to control at leastone of speed and length of retraction of the at least one tether by thetethering component. For example, computing component 2120 can includecircuitry configured to control speed, distance traveled, anddirectionality of the tethering component.

In an aspect, computing component 2120 includes circuitry configured tocontrol the motor 2160. For example, computing component 2120 caninclude circuitry configured to control rotational frequency of themotor. In an aspect, computing component 2120 includes circuitryconfigured to control at least one of extension and retraction of the atleast one tether by the tethering component and the rotational frequencyof the motor operably coupled to the tethering component to generate acutting pattern. In an aspect, the cutting pattern is symmetric. Forexample, the cutting pattern can be a sphere or an oval. In an aspect,the cutting pattern is asymmetric. For example, securing the at leastone tether closer to one end of the elongated flexible cutting componentthan to the other end results in an asymmetric cutting pattern uponretraction of the at least one tether.

In an aspect, computing component 2120 can take various forms or be partof an object, and can include, but is not limited to, a computer, alaptop computer, a personal electronic device, a dedicated computingdevice, a limited resource computing device, a wireless communicationdevice, a mobile wireless communication device, a handheld electronicwriting device, a tablet, a digital camera, a scanner, a cell phone, aPDA, an electronic tablet device, a printer, or any other like devicethat takes information as an input and gives it back to the end-users.Computing component 2120 can include a digital single processor, ASIC,microprocessor, or other type of processor operating on a system such asa personal computer, server, a router, or other device capable ofprocessing data including network interconnection device. Other aspectsof a computing component have been described above herein.

FIG. 22 illustrates further aspects of a tissue cutting system includinga tissue cutting device and a computing component. Tissue cutting system2200 includes tissue cutting device 2205 and computing component 2210.Tissue cutting device 2205 includes tethering component 2215, elongatedflexible cutting component 2220, and at least one tether 2225. Tetheringcomponent 2215 is operably coupled to motor 2230, motor 2230 includingcircuitry configured to rotate tethering component 2215. Computingdevice 2210 is operably coupled to tissue cutting device 2205 throughcommunication link 2290. Communication link 2290 can include a wirelessor a wired communication link, non-limiting examples of which have beendescribed above herein.

In some embodiments, system 2200 includes an aspiration componentconfigured to aspirate tissue debris in proximity to the elongatedflexible cutting component, the aspiration component including a vacuumsource and an aspirator connected to the vacuum source. In an aspect, atleast a portion of the aspiration component is incorporated into thetissue cutting device. In some embodiments, a non-limiting example ofwhich is shown in FIG. 22, the aspiration component includes an externalvacuum source 2235 attached to an aspirator 2240 through a flow conduit2245. In an aspect, the aspirator of the aspiration component includes asuction tube positioned proximal to the elongated flexible cuttingcomponent of the tissue cutting device, the suction tube connected tothe vacuum source. For example, the aspirator of the aspirationcomponent can include a suction tube disposed in and defined by the atleast one tether, e.g., a hollow rod. In some embodiments, theaspiration component is not physically attached to the tissue cuttingdevice, but includes a separate aspirator held in a second hand or by asecond individual.

In some embodiments, tissue cutting system 2200 includes an irrigationcomponent configured to irrigate tissue in proximity to the elongatedflexible cutting component, the irrigation component including a flowconduit attached to an irrigation fluid reservoir. In an aspect, theflow conduit includes an irrigation tube positioned proximal to theelongated flexible cutting component, the irrigation tube connected tothe irrigation fluid reservoir. In an aspect, the flow conduit includesan irrigation tube positioned outside a cutting radius of the elongatedflexible cutting component. In an aspect, the flow conduit includes anirrigation tube positioned inside a cutting radius of the elongatedflexible cutting component. For example, the irrigation tube can bedisposed in and defined by the at least one tether, e.g., a hollow rod.In an aspect, at least a portion of the irrigation component isincorporated into tissue cutting device 2205. In some embodiments, anon-limiting example of which is shown in FIG. 22, the irrigationcomponent includes an external irrigation fluid reservoir 2250 attachedto an irrigation tube 2255 through a flow conduit 2260. Irrigation fluidreservoir 2250 is configured to hold and controllably release at leastone irrigation fluid. In an aspect, the at least one irrigation fluidincludes at least one of saline, a buffer, a therapeutic agent, anantimicrobial agent, an anesthetic, or a coagulant agent. Non-limitingexamples of irrigation fluids have been described above herein. In anaspect, the irrigation component is configured to wet at least a portionof the elongated flexible cutting component. In some embodiments, system2200 includes an aspiration component and an irrigation component.

In some embodiments, tissue cutting system 2200 includes animage-capture device 2265. In an aspect, image-capture device 2265 isoperably coupled to computing component 2210. Computing component 2225includes circuitry configured to receive image data from theimage-capture device 2265. In an aspect, the received image data includeone or more images of a tissue in proximity to the elongated flexiblecutting component 2220 of the tissue cutting device 2205. In an aspect,computing component 2210 includes circuitry configured to control atleast one of the tethering component 2215 and/or the motor 2230 oftissue cutting device 2205 in response to the received image data. In anaspect, image-capture device 2265 includes an optical image-capturedevice. In an aspect, image-capture device 2265 includes an ultrasoundimage-capture device. In some embodiments, at least a portion of theimage-capture device is incorporated into the tissue cutting device. Insome embodiments, the image-capture device, for example a digitalcamera, is external to the tissue cutting device, but capable oftransmitting image data to the computing component of the system.Non-limiting examples of image-capture device have been described aboveherein.

In some embodiments, tissue cutting system 2200 includes at least oneanalyte sensor 2270. The at least one analyte sensor is configured tosense a property of one or more analytes in an aspirate. In an aspect,at least a portion of the at least one analyte sensor is incorporatedinto the tissue cutting device, such as shown in the non-limitingexample of FIG. 22. In an aspect, the at least one analyte sensorincludes at least one of an optical sensor, a magnetic sensor, anelectrical sensor, an acoustic sensor, or a chemical sensor. In anaspect, the at least one analyte sensor is configured to sense anoptical property, a fluorescence property, a magnetic property, anelectrical property, an electromagnetic property, an acoustic property,or a chemical property of the one or more analytes in the aspirate. Inan aspect, the at least one analyte sensor 2270 is operably coupled tothe computing component 2210, the computing component 2210 includingcircuitry configured to receive sensor input from the at least oneanalyte sensor 2270 and to control at least one of the tetheringcomponent 2215 and the motor 2230 of tissue cutting device 2205 inresponse to the received sensor input. Non-limiting examples of analytesensors have been described above herein.

In some embodiments, tissue cutting system 2200 includes a dragcompensation component 2275. In an aspect, drag compensation component2275 includes circuitry configured to measure drag from the elongatedflexible cutting component 2220 during rotation, the drag compensationcomponent 2275 operably coupled to computing component 2210, thecomputing component 2210 including circuitry configured to control atleast one of the tethering component and the motor of the tissue cuttingdevice in response to the measured drag.

In some embodiments, tissue cutting system 2200 includes a torquecompensation component 2280. The torque compensation component 2280includes circuitry configured to prevent oscillation. In an aspect, thetorque compensation component includes at least one counterweight. In anaspect, the at least one counterweight is extendable.

In some embodiments, tissue cutting system 2200 includes a cauterycomponent 2285 to cauterize tissue. For example, the cautery componentcan be configured to cauterize tissue during and/or after a cuttingprocedure. In an aspect, cautery component 2285 is operably coupled tothe elongated flexible cutting component 2220. For example, theelongated flexible cutting component can cauterize the tissue during thecutting procedure. In an aspect, cautery component 2285 includes anelectrical cautery component. In an aspect, cautery component 2285includes an optical cautery component. In an aspect, cautery component2285 includes a thermal cautery component. In an aspect, cauterycomponent 2285 includes a chemical cautery component. Non-limitingexamples of a cautery component have been described above herein.

Tissue Cutting Device

In some embodiments, a tissue cutting device includes a centralrotatable shaft having a first end and a second end; a motor operablycoupled to the first end of the central rotatable shaft, the motorincluding circuitry configured to rotate the central rotatable shaft; atethering component; and an elongated flexible cutting component havinga first end and a second end, the first end of the elongated flexiblecutting component secured to the central rotatable shaft at a positionbetween the first end and the second end of the central rotatable shaft,the second end of the elongated flexible cutting component operablycoupled to the tethering component, the tethering component includingconfigured to at least one of extend and retract the elongated flexiblecutting component; wherein the extension and retraction of the elongatedflexible cutting component by the tethering component changes a shapeformed by the elongated flexible cutting component.

In some embodiments, at least a portion of the elongated flexiblecutting component between the first end and the second end of theelongated flexible cutting component is disposed in a lumen defined bythe central rotatable shaft. For example, the second end of theelongated flexible cutting component can be fed through a lumen definedby the central rotatable shaft to attach to the tethering component.FIG. 23 illustrates aspects of a tissue cutting device including anelongated flexible cutting component disposed in a lumen defined by thecentral rotatable shaft. Tissue cutting device 2300 includes centralrotatable shaft 2310 having a first end 2320 and a second end 2330.Tissue cutting device 2300 further includes motor 2340 operably coupledto the first end 2320 of the central rotatable shaft 2310. Motor 2340includes circuitry configured to rotate central rotatable shaft 2310.Tissue cutting device 2300 includes tethering component 2350 andelongated flexible cutting component 2360. Elongated flexible cuttingcomponent 2360 has a first end 2370 and a second end 2380. The first end2370 of the elongated flexible cutting component 2360 is secured to thecentral rotatable shaft 2310 at a position between the first end 2320and the second 2330 of the central rotatable shaft 2310. At least aportion of the elongated flexible cutting component 2360 between thefirst end 2370 and the second end 2380 of the elongated flexible cuttingcomponent 2360 is disposed in a lumen 2390 defined by the centralrotatable shaft. The second end 2380 of the elongated flexible cuttingcomponent 2360 is operably coupled to the tethering component 2350. Thetethering component 2350 is configured to at least one of extend andretract the elongated flexible cutting component 2360 to change a shapeformed by the elongated flexible cutting component 2360.

In some embodiments, at least a portion of the elongated flexiblecutting component between the first end and the second end of theelongated flexible cutting component extends past a rotatable elementassociated with the central rotatable shaft. In an aspect, the rotatableelement includes a pulley. In an aspect, the rotatable element includesa fly wheel. In an aspect, the rotatable element is attached to theexterior of the central rotatable shaft. FIG. 24 illustrates an aspectof a tissue cutting device including a rotatable element. Tissue cuttingdevice 2400 includes central rotatable shaft 2410 having a first end2420 and a second end 2430. Tissue cutting device 2400 further includesmotor 2440 operably coupled to the first end 2420 of the centralrotatable shaft 2410. Motor 2440 includes circuitry configured to rotatecentral rotatable shaft 2410. Tissue cutting device 2400 includestethering component 2450 and elongated flexible cutting component 2460.Elongated flexible cutting component 2460 has a first end 2470 and asecond end 2480. The first end of the elongated flexible cuttingcomponent is secured to the central rotatable shaft at a positionbetween the first end and the second end of the central rotatable shaft.In the non-limiting example shown in FIG. 24, first end 2470 of theelongated flexible cutting component 2460 is secured to the centralrotatable shaft 2410 at a position in proximity to the second end 2430of the central rotatable shaft 2410. At least a portion of the elongatedflexible cutting component 2460 between the first end 2470 and thesecond end 2480 of the elongated flexible cutting component 2460 extendspast a rotatable element 2490 on the central rotatable shaft 2460. Thesecond end 2480 of the elongated flexible cutting component 2460 isoperably coupled to the tethering component 2450. The tetheringcomponent 2450 is configured to at least one of extend and retract theelongated flexible cutting component 2460 to change a shape formed bythe elongated flexible cutting component 2460.

In an aspect, the elongated flexible cutting component forms a D-shape.In an aspect, the elongated flexible cutting component attached at afirst end to the central rotatable shaft and at the second end to thetethering component and is at least partially disposed in a lumendefined by the central rotatable shaft forms a D-shape. In an aspect, anelongated flexible cutting component attached at a first end to thecentral rotatable shaft and at a second end to the tethering componentand a portion of which extends past a rotatable element on the centralrotatable shaft forms a D-shape. In an aspect, the tethering component,by either extending or retracting the elongated flexible cuttingcomponent, controls the D-shape formed by the elongated flexible cuttingcomponent. For example, the D-shape can be lengthened and narrowed asthe tethering component extends the elongated flexible cuttingcomponent. For example, the D-shape can be shortened and widened as thetethering component retracts the elongated flexible cutting component.

In an aspect, the shape formed by the elongated flexible cuttingcomponent is fixed. For example, the tethering component can extend orretract the elongated flexible cutting component to a set position thatis locked into place prior to a cutting procedure to create a definedlength of elongated flexible cutting component, the radius of the shapeformed by the elongated flexible cutting component remaining constantand creating a symmetrical cutting pattern.

In an aspect, the shape formed by the elongated flexible cuttingcomponent varies through the course of the resection. For example, theradius of the rotating elongated flexible cutting component can vary asthe tissue cutting device is moved into the tissue, with a small cuttingradius at the point of entering the tissue and a larger cutting radiusonce the target tissue for resection has been reached.

FIGS. 25A and 25B illustrate changes in the shape formed by theelongated flexible cutting component as well as the tissue cuttingpattern in response to extending and retracting the elongated flexiblecutting component. FIG. 25A shows tissue cutting device 2300 at a firsttime point relative to tissue 2500. Tissue cutting device 2300 includescentral rotatable shaft 2310, motor 2340, tethering component 2350, andelongated flexible cutting component 2360. At least a portion of theelongated flexible cutting component 2360 between the first end and thesecond end of the elongated flexible cutting component 2360 is disposedin a lumen 2390 defined by the central rotatable shaft 2310. Tissuecutting device 2300 is shown cutting into tissue 2500 and target tissuemass 2510. Tethering component 2350, shown in this example as arotatable reel 2520, has retracted elongated flexible cutting component2360 to a first position that creates resected space 2530 as centralrotatable shaft 2310 and attached elongated flexible cutting component2360 are rotated by motor 2340. As the elongated flexible cuttingcomponent 2360 rotates, it cuts away at tissue 2500 in a patterndependent upon the shape formed by the elongated flexible cuttingcomponent 2360. FIG. 25B shows tissue cutting device 2300 at a secondtime point relative to tissue 2500. At this point, central rotatableshaft 2310 is shown further into tissue 2500. Tethering component 2350has extended elongated flexible cutting component 2360 to a secondposition that creates resected space 2540 as central rotatable shaft2310 and attached elongated flexible cutting component 2360 are rotatedby motor 2340. In this example, tissue mass 2510 has been removed,leaving resected space 2540.

In an aspect, a tissue cutting device such as described herein is usedfor minimally invasive surgery to cut and resect tissue. In an aspect,the tissue cutting device is inserted into a tissue of a patient. Insome embodiments, the distal portion of the tissue cutting device (e.g.,the second end of the central rotatable shaft) is adapted to piercetissue. In other embodiments, the tissue cutting device is inserted intoa previously established surgical incision (e.g., a 0.5 cm to 2 cmincision). In an aspect, the tissue cutting device is inserted into abody lumen (e.g., a blood vessel, gastrointestinal tract, vagina,rectum, airway, ureter, or urethra).

A tissue cutting device such as described herein can enter tissue by anyof a number of routes including, but not limited to, transabdominal,transperineal, transcutaneous, transvascular, transurethral,transureteral, transoral, transvaginal, and transrectal routes ofinsertion. A wide range of tissue can be cut and resected including butnot limited to prostatic tissue, kidney tissue, liver tissue, uterinetissue, bladder tissue, and brain tissue. In an aspect, the tissue to becut and resected is benign tissue (e.g., fibrotic tissue in uterus orprostate). In an aspect, the tissue to be cut and resected is malignanttissue (e.g., a solid tumor).

In an aspect, the tissue cutting device is sized for placement intocannula or trocar. For example, the central rotatable shaft andelongated flexible cutting component of the tissue cutting device may beextended from or retracted into a cannula or trocar configured forperforming minimally invasive surgery.

A tissue cutting device such as described in FIGS. 23 and 24 includes atethering component configured to at least one of extend and retract theelongated flexible cutting component. In an aspect, the tetheringcomponent includes a manual tethering component. For example, thetethering component can include a fastening device for holding theelongated flexible cutting component to a specific length. For example,the fastening device can include a clamping device, a holding device, aclinching device, a cinching device, an anchoring device, a hitchingdevice, or a securing device. For example, the fastening device caninclude a clamp, a snap, a screw, or a pin. For example, the tetheringcomponent can include a “pull-through” function in which the elongatedflexible cutting component (e.g., a wire, string, strand, fiber, thread,or ribbon) is pulled through a closable fastening device until theappropriate length is reached and the closable fastening device isclosed.

In an aspect, the tethering component includes a securing device, thesecuring device configured to secure the elongated flexible cuttingcomponent at a specified length. For example, the tethering componentcan include a lockable clamp. For example, the tethering component caninclude at least one lockable gear with a gripping surface (e.g., teeth,abrasive, or adhesive) designed to interact with the elongated flexiblecutting component and prevent slippage. For example, the tetheringcomponent can include a hinged or pivoted device, e.g., a pawl, adaptedto fit into a notch of a ratchet wheel to impart extension and/orretraction or to prevent extension and/or retraction.

In some embodiments, the tethering component includes circuitryconfigured to extend and retract the elongated flexible cuttingcomponent. For example, the tethering component can include a ratchet orgears configured to controllably extend and/or retract the elongatedflexible cutting component. For example, the tethering component caninclude a motorized ratchet or gears configured to controllably extendand/or retract the elongated flexible cutting component. In an aspect,the tethering component includes circuitry configured to either extendor retract the elongated flexible cutting component. For example, thetethering component can include a locking component and a retractioncomponent, the elongated flexible cutting component extended bycentrifugal force of rotation, locked after sufficient extension, andretracted by the retraction component. In an aspect, the tetheringcomponent includes at least one rotatable component, the second end ofthe elongated flexible cutting component secured to the at least onerotatable component, the at least one rotatable component configured toat least one of extend and retract the elongated flexible cuttingcomponent. For example, the tethering component can include a rotatablegear to which the second end of the elongated flexible cutting componentis secured and a second motor including circuitry configured to rotatethe rotatable gear to at least one of extend and retract the attachedelongated flexible cutting component. For example, the at least onerotatable component can be configured to extend and/or retract theattached elongated flexible cutting component

In an aspect, the tethering component is attached to the centralrotatable shaft. For example, the tethering component can include arotatable reel associated with the central rotatable shaft. In anaspect, the tethering component is disposed in a lumen defined by thecentral rotatable shaft. In an aspect, the tethering component isconfigured to rotate with the central rotatable shaft.

A tissue cutting device such as described in FIGS. 23 and 24 includes anelongated flexible cutting component. In an aspect, the elongatedflexible cutting component is formed from metal. In an aspect, theelongated flexible cutting component is formed from at least onepolymer. In an aspect, the elongated flexible cutting component isformed from at least one natural fiber. In an aspect, the elongatedflexible cutting component is formed from at least one man-made fiber.In an aspect, the elongated flexible cutting component is at least oneof a flexible wire, strand, string, fiber, thread, or ribbon. In anaspect, the elongated flexible cutting component includes a non-circularcross-section. In an aspect, the elongated flexible cutting componentincludes at least one cutting edge. In an aspect, the elongated flexiblecutting component includes at least one serrated edge. In an aspect, theelongated flexible cutting component is replaceable.

In some embodiments, a tissue cutting device includes two or moreelongated flexible cutting components. In an aspect, a first end of eachof the two or more elongated flexible cutting components is secured tothe central rotatable shaft and the second end of each of the two ormore elongated flexible cutting components is operably coupled to thetethering component.

In some embodiments, a tissue cutting device such as described in FIGS.23 and 24 includes an aspiration component configured to aspirate tissuedebris in proximity to the central rotatable shaft. In an aspect, theaspiration component includes a vacuum source and an aspirator connectedto the vacuum source. FIGS. 26-28 illustrate aspects of a tissue cuttingdevice including an aspiration component.

In an aspect, the aspirator of the aspiration component includes asuction tube positioned proximal to the central rotatable shaft of thetissue cutting component, the suction tube connected to the vacuumsource. FIG. 26 illustrates a non-limiting embodiment of a tissuecutting device including a suction tube. FIG. 26 shows tissue cuttingdevice 2600 including central rotatable shaft 2410 operably coupled tomotor 2440. Elongated flexible cutting component 2460 is shown attachedat a first end to central rotatable shaft 2410 and at a second end totethering component 2450. At least a portion of elongated flexiblecutting component 2460 extends past rotatable element 2490. Tissuecutting device 2600 further includes vacuum source 2610. Vacuum source2610 is in fluid communication with suction tube 2620. Suction tube 2620extends from handle casing 2630 into a region in proximity to centralrotatable shaft 2410 and is configured to aspirate tissue debrisresected by the rotating elongated flexible cutting component 2460.

In an aspect, the aspirator includes a suction lumen disposed in anddefined by the central rotatable shaft, the suction lumen connected tothe vacuum source and in fluid communication with one or more openingsdefined by the central rotatable shaft. In an aspect, the one or moreopenings defined by the central rotatable shaft include a singleopening. For example, the one opening can be position at or near the endof the central rotatable shaft. FIG. 27 illustrates a non-limitingembodiment of a tissue cutting device including a suction lumen and oneopening defined by the central rotatable shaft. FIG. 27 shows tissuecutting device 2700 including central rotatable shaft 2710 operablycoupled to motor 2440. Elongated flexible cutting component 2460 isshown attached at a first end to central rotatable shaft 2710 and at asecond end to tethering component 2450. At least a portion of elongatedflexible cutting component 2460 extends past rotatable element 2490.Tissue cutting device 2700 further includes vacuum source 2720. Centralrotatable shaft 2710 further includes a suction lumen 2730 disposed inand defined by central rotatable shaft 2710. Suction lumen 2730 isconnected to vacuum source 2720 and is in fluid communication with anopening 2740 defined by central rotatable shaft 2710. In thisnon-limiting embodiment, tissue cutting device 2700 is configured toaspirate tissue debris generated by the rotation of elongated flexiblecutting component 2460 into opening 2740, aspirate the debris throughsuction lumen 2730, and into vacuum source 2720.

In an aspect, the one or more openings defined by the central rotatableshaft are positioned along the length of the central rotatable shaft.For example, the tissue cutting device can include a single openingsomewhere along the length of the central rotatable shaft. For example,the tissue cutting device can include a plurality of openings positionedalong the length of the central rotatable shaft. FIG. 28 illustrates anon-limiting embodiment of a tissue cutting device include a suctionlumen and a plurality of openings defined by the central rotatableshaft. FIG. 28 shows tissue cutting device 2800 including centralrotatable shaft 2810 operably coupled to motor 2440. Elongated flexiblecutting component 2460 is shown attached at a first end to centralrotatable shaft 2810 and at a second end to tethering component 2450. Atleast a portion of elongated flexible cutting component 2460 extendspast rotatable element 2490. Tissue cutting device 2800 further includesvacuum source 2820. Central rotatable shaft 2810 further includes asuction lumen 2830 disposed in and defined by central rotatable shaft2810. Suction lumen 2830 is connected to vacuum source 2820 and is influid communication with openings 2840 defined by and positioned alongthe length of central rotatable shaft 2810. In this non-limitingembodiment, tissue cutting device 2800 is configured to aspirate tissuedebris generated by the rotation of elongated flexible cutting component2460 into openings 2840, aspirate the debris through suction lumen 2830,and into vacuum source 2820.

In an aspect, the vacuum source is at least partially contained within ahand-held housing of the tissue cutting device. For example, vacuumsource can include any of a number of small, commercially available minivacuum pumps sized for use in small appliances (from, e.g., Vaccon Co,Inc., Medway, Mass.; Hargraves Technology Corp, Mooresville, N.C.). Inan aspect, the vacuum source is external to the tissue cutting device,e.g., a large vacuum pump, but connected, e.g., by a fitting, luer, orconnection, to the aspirator through a vacuum conduit, e.g., a hose ortubing. In an aspect, the external vacuum source includes an aspiratorpump, e.g., a water aspirator.

FIG. 29 illustrates further aspects of a tissue cutting device such asshown in FIGS. 23 and 24. Tissue cutting device 2900 includes centralrotatable shaft 2905 operably coupled to motor 2910 and elongatedflexible cutting component 2915 secured at one end to the centralrotatable shaft 2905 (not shown in this view) and at the second end totethering component 2920. At least a portion of elongated flexiblecutting component 2915 extends past rotatable element 2925.

Tissue cutting device 2900 further includes computing component 2930including a processor and circuitry. Non-limiting aspects of a computingcomponent have been described above herein. In an aspect, the computingcomponent 2930 is operably coupled to at least one of the motor 2910 andthe tethering component 2920. In an aspect, computing component 2930includes circuitry configured to control the motor. For example, thecomputing component can include circuitry configured to control torotational rate or frequency of the motor. In an aspect, the computingcomponent 2930 includes circuitry configured to control the tetheringcomponent. In an aspect, the computing component 2930 includes circuitryconfigured to control at least one of extension and retraction of theelongated flexible cutting component by the tethering component. Forexample, the computing component can include circuitry configured tocontrol extension and/or retraction of the elongated flexible cuttingcomponent by the tethering component. For example, the computingcomponent can include circuitry configured to control at least one ofspeed and length of extension of the elongated flexible cuttingcomponent by the tethering component. For example, the computingcomponent can include circuitry configured to control at least one ofspeed and length of retraction of the elongated flexible cuttingcomponent. For example, the computing component can include circuitryconfigured to control speed, distance traveled, and directionality ofthe tethering component. In an aspect, computing component 2930 isoperably coupled to one or more other components of tissue cuttingdevice 2900.

Tissue cutting device 2900 further includes power source 2935. Forexample, tissue cutting device 2900 can include an electrical cord foruse with an electrical outlet. For example, tissue cutting device 2900can include one or more batteries. Non-limiting examples of powersources have been described above herein.

In some embodiments, tissue cutting device 2900 includes an aspirationcomponent configured to aspirate tissue debris in proximity to centralrotatable shaft 2910. The aspiration component includes a vacuum sourceand an aspirator connected to the vacuum source. In some embodiments, asshown in FIG. 29, the aspiration component includes vacuum source 2940and aspirator 2945 connected to vacuum source 2940, aspirator 2945including a suction lumen positioned proximal to central rotatable shaft2910. In some embodiments, such as shown in FIGS. 27 and 28, theaspirator includes a suction lumen disposed in and defined by thecentral rotatable shaft, the suction lumen connected to the vacuumsource and in fluid communication with one or more openings defined bythe central rotatable shaft.

In some embodiments, tissue cutting device 2900 includes an irrigationcomponent configured to irrigate tissue in proximity to the centralrotatable shaft. The irrigation component includes an irrigation fluidreservoir and a flow conduit. In some embodiments, such as shown in FIG.29, the flow conduit includes an irrigation tube 2955 positionedproximal to the central rotatable shaft 2910, the irrigation tubeconnected to the irrigation fluid reservoir 2950. In some embodiments,the flow conduit includes an irrigation lumen disposed in and defined bythe central rotatable shaft, the irrigation lumen connected to theirrigation fluid reservoir and in fluid communication with one or moreopenings defined by the central rotatable shaft. In an aspect, the oneor more openings defined by the central rotatable shaft are positionedalong the length of the central rotatable shaft. In an aspect,irrigation fluid reservoir 2950 is configured to hold and controllablyrelease at least one irrigation fluid. In an aspect, the at least oneirrigation fluid includes at least one of saline, a buffer, atherapeutic agent, an antimicrobial agent, an anesthetic, or a coagulantagent. In an aspect, the irrigation component is configured to wet theelongated flexible cutting component. For example, the irrigationcomponent can be configured to wet the elongated flexible cuttingcomponent with an irrigation fluid before, during, and/or after acutting procedure. In some embodiments, tissue cutting device 2900includes an aspiration component and an irrigation component.

In some embodiments, tissue cutting device 2900 includes at least oneanalyte sensor 2960. In an aspect, the at least one analyte sensorincludes at least one of an optical sensor, a magnetic sensor, anelectrical sensor, an acoustic sensor, or a chemical sensor.Non-limiting examples of analyte sensors have been described aboveherein. In an aspect, the at least one analyte sensor is configured tosense a property of one or more analytes in an aspirate. In an aspect,the at least one analyte sensor is configured to sense an opticalproperty, a fluorescence property, a magnetic property, an electricalproperty, an electromagnetic property, an acoustic property, or achemical property of the one or more analytes in the aspirate. In someembodiments, such as shown in FIG. 29, the at least one analyte sensor2960 is in fluid communication with the aspirator 2945 and/or the vacuumsource 2940. For example, the at least one analyte sensor can beposition to sense a property of an aspirate as it flows through theaspirator and into the vacuum source. In an aspect, the at least oneanalyte sensor is configured to sense in situ a property of the targettissue before, during, and/or after the resection procedure. Forexample, the at least one analyte sensor can be configured to sense insitu an optical property, a fluorescence property, a magnetic property,an electrical property, electromagnetic property, acoustic property, orchemical property of the target tissue before, during, and/or after theresection procedure.

In some embodiments, tissue cutting device 2900 includes animage-capture device 2965. The image-capture device 2965 is operablycoupled to a computing component 2930, the computing component 2930including circuitry configured to receive image data from image-capturedevice 2965. In an aspect, the image data includes one or more images oftissue in proximity to the central rotatable shaft and/or the elongatedflexible cutting component before, during, and/or after a resectionprocedure. In an aspect, image-capture device 2965 includes an opticalimage-capture device. For example, image-capture device 2965 can includea digital camera, a fluoroscope, or a laparoscope. In an aspect,image-capture device 2965 includes an ultrasound image-capture device.

In some embodiments, tissue cutting device 2900 includes a dragcompensation component 2970. For example, the drag compensationcomponent can include at least one spar and one or more stays tocompensate for drag associated with the rotating elongated flexiblecutting component, a non-limiting example of which is illustrated inFIGS. 12A and 12B. In an aspect, the drag compensation component 2970includes circuitry configured to measure drag from the elongatedflexible cutting component during rotation. For example, the dragcompensation component can include a transceiver and one or morereflectors for use in measuring drag associated with the rotatingelongated flexible cutting component, a non-limiting example of which isshown in FIGS. 13A-C. In an aspect, a drag compensation component 2970is operably coupled to a computing component 2930, the computingcomponent 2930 including circuitry configured to control at least one ofthe motor 2910 and the tethering component 2920 in response to themeasured drag. For example, the computing component can includecircuitry configured to control the motor and/or the tethering componentin response to the measured drag of the elongated flexible cuttingcomponent.

In some embodiments, tissue cutting device 2900 includes a torquecompensation component 2975. In an aspect, the torque compensationcomponent includes circuitry configured to prevent oscillation. Forexample, the torque compensation component can include circuitryconfigured to prevent oscillation when executing asymmetric cuttingpatterns. In an aspect, the torque compensation component includes atleast one counterweight. For example, the torque compensation componentcan include at least one counterweight associated with the centralrotatable shaft and configured to pivot in response to changes in theshape formed by the elongated flexible cutting component. In an aspect,the at least one counterweight is extendable. Non-limiting examples oftorque compensation components including counterweights are illustratedin FIGS. 10A-C and FIGS. 11A-C.

In some embodiments, tissue cutting device 2900 includes a cauterycomponent 2980. In an aspect, the cautery component is configured tocauterize tissue. For example, the cautery component can be configuredto cauterize tissue during and/or after a cutting procedure. In anaspect, the cautery component is operably coupled to the elongatedflexible cutting component. For example, the elongated flexible cuttingcomponent can be electrified and/or heated to cauterize while cutting.The cautery component includes at least one of an electrical cauterycomponent, an optical cautery component, a thermal cautery component, ora chemical cautery component.

In an aspect, tissue cutting device 2900 further includes a handlecasing 2985, the handle casing covering at least a portion of the motor,the handle casing including a user interface. In an aspect, the handlecasing is sized for use with a single hand. In an aspect, the handlecasing further covers one or more other components of the tissue cuttingdevice (e.g., the tethering component, a computing component, anaspiration component, an irrigation component, an image-capture device,at least one analyte sensor, a torque compensation component, a dragcompensation component, a cautery component, or a power source). In anaspect, the handle casing includes a user interface. In an aspect, theuser interface includes at least one of an on/off switch, buttons,display screen, touchscreen, microphone, speakers, and the like forentering and receiving information.

Tissue Cutting System

Described herein are embodiments of a tissue cutting system including atissue cutting device and a computing component, the tissue cuttingdevice including a central rotatable shaft having a first end and asecond end; a motor operably coupled to the first end of the centralrotatable shaft, the motor including circuitry configured to rotate thecentral rotatable shaft; a tethering component; and an elongatedflexible cutting component having a first end and a second end, thefirst end of the elongated flexible cutting component secured to thecentral rotatable shaft at a position between the first and the secondend of the central rotatable shaft, the second end of the elongatedflexible cutting component operably coupled to the tethering component,the tethering component configured to at least one of extend and retractthe elongated flexible cutting component; and the computing componentoperably coupled to the tissue cutting device, the computing componentincluding a processor and circuitry.

FIG. 30 illustrates aspects of a tissue cutting system. System 3000includes tissue cutting device 3010 and computing component 3020. Tissuecutting device 3010 includes central rotatable shaft 3030 operablyconnected at one end to motor 3040. Tissue cutting device 3010 furtherincludes elongated flexible cutting component 3060 secured at a firstend to central rotatable shaft 3030 and at a second end to tetheringcomponent 3050. In some embodiments, at least a portion of elongatedflexible cutting component 3060 of the tissue cutting device 3010between the first end and the second end of the elongated flexiblecutting component 3060 is disposed in a lumen 3070 defined by thecentral rotatable shaft 3030 of the tissue cutting device. In someembodiments, at least a portion of the elongated flexible cuttingcomponent of the tissue cutting device between the first and the secondend of the elongated flexible cutting component extends past a rotatableelement on the central rotatable shaft of the tissue cutting device. Inan aspect, the rotatable element includes a pulley or a flywheel. In anaspect, the rotatable element is attached to the exterior of the centralrotatable shaft.

Tissue cutting device 3010 of tissue cutting system 3000 includestethering component 3050. In an aspect, the tethering component of thetissue cutting device includes circuitry configured to at least one ofextend and retract the elongated flexible cutting component. In anaspect, extension and retraction of the elongated flexible cuttingcomponent by the tethering component of the tissue cutting devicechanges a shape formed by the elongated flexible cutting component. Forexample, extension of the elongated flexible cutting component lengthensand narrows a D-shape formed by the elongated flexible cuttingcomponent. For example, retraction of the elongated flexible cuttingcomponent shortens and widens a D-shape formed by the elongated flexiblecutting component. In an aspect, the tethering component of the tissuecutting device includes at least one rotatable component, the second endof the elongated flexible cutting component of the tissue cutting devicesecured to the at least rotatable component, the at least one rotatablecomponent configured to at least one of extend and retract the elongatedflexible cutting component. In an aspect, the tethering component of thetissue cutting device includes a securing device, the securing device tosecure the elongated flexible cutting component to a length. In anaspect, the tethering component is attached to the central rotatableshaft. In an aspect, the tethering component of the tissue cuttingdevice is disposed in a lumen defined by the central rotatable shaft. Inan aspect, the tethering component of the tissue cutting device isconfigured to rotate with the central rotatable shaft.

Tissue cutting device 3010 of tissue cutting system 3000 includeselongated flexible cutting component 3060. In an aspect, the elongatedflexible cutting component of the tissue cutting device is formed frommetal. In an aspect, the elongated flexible cutting component of thetissue cutting device is formed from at least one polymer. In an aspect,the elongated flexible cutting component of the tissue cutting device isformed from at least one natural fiber. In an aspect, the elongatedflexible cutting component of the tissue cutting device is formed fromat least one man-made fiber. In an aspect, the elongated flexiblecutting component of the tissue cutting device is at least one of aflexible wire, strand, string, fiber, thread, or ribbon. In an aspect,the elongated flexible cutting component of the tissue cutting deviceincludes a non-circular cross-section. In an aspect, the elongatedflexible cutting component of the tissue cutting device includes atleast one cutting edge. In an aspect, the elongated flexible cuttingcomponent of the tissue cutting device includes at least one serratededge. In an aspect, the elongated flexible cutting component of thetissue cutting device is replaceable. In an aspect, the tissue cuttingdevice includes two or more elongated flexible cutting components.

Tissue cutting device 3010 and computing component 3020 are operablyconnected through a communication link 3080. Communication link 3080 caninclude at least one of a wireless communication link, e.g., Bluetoothor other radio transmission link, or a wired communication link, e.g.,an electrical link. Tissue cutting device 3010 of system 3000 is shownin the process of cutting tissue 3090, the shape of the resected tissuedictated by the shape formed by the rotating elongated flexible cuttingcomponent. In an aspect, the computing component 3020 includes circuitryconfigured to control the motor 3040. For example, computing component3020 can include circuitry configured to control the rotationalfrequency of motor 3040, e.g., the speed at which the central rotatableshaft is rotated. In an aspect, the computing component 3020 includescircuitry configured to control the tethering component 3050. In anaspect, computing component 3020 includes circuitry configured tocontrol at least one of extension and retraction of the elongatedflexible cutting component 3060 by tethering component 3050. Forexample, the computing component can include circuitry configured tocontrol at least one of speed and length of extension of the elongatedflexible cutting component by the tethering component. For example, thecomputing component can include circuitry configured to control at leastone of speed and length of retraction of the elongated flexible cuttingcomponent by the tethering component. In an aspect, the computingcomponent 3020 includes circuitry configured to control at least one ofextension and retraction of the elongated flexible cutting component3060 by the tethering component 3050 and the rotational frequency of themotor 3040 operably coupled to the central rotatable shaft 3030 togenerate a cutting pattern. In an aspect, the cutting pattern issymmetrical. For example, the rotational frequency of the motor and thelength of the elongated flexible cutting component remain constantthrough a 360 degree rotational event. In an aspect, the cutting patternis asymmetrical. For example, the rotational frequency of the motor andthe length of the elongated flexible cutting component vary through a360 degree rotational event.

In an aspect, computing component 3020 can take various forms or be partof an object, and can include, but is not limited to, a computer, alaptop computer, a personal electronic device, a dedicated computingdevice, a limited resource computing device, a wireless communicationdevice, a mobile wireless communication device, a handheld electronicwriting device, a tablet, a digital camera, a scanner, a cell phone, aPDA, an electronic tablet device, a printer, or any other like devicethat takes information as an input and gives it back to the end-users.Computing component 3020 can include a digital single processor, ASIC,microprocessor, or other type of processor operating on a system such asa personal computer, server, a router, of other device capable ofprocessing data including network interconnection device. Other aspectsof a computing component have been described above herein.

FIG. 31 illustrates further aspects of a tissue cutting system. In anaspect, system 3100 includes tissue cutting device 3105 and computingcomponent 3110. Computing component 3110 is operably coupled to tissuecutting device 3105 through a communication link 3108, e.g., a wirelessor wired communication link. Tissue cutting device 3105 includes centralrotatable shaft 3115 operably coupled at a first end 3120 to motor 3125.Tissue cutting device 3105 further includes elongated flexible cuttingcomponent 3130 secured at a first end to the central rotatable shaft3115 and at a second end to tethering component 3135. In thisnon-limiting embodiment, at least a portion of elongated flexiblecutting component 3130 of tissue cutting device 3105 between the firstand the second end of the elongated flexible cutting component 3130 isdisposed in a lumen 3140 defined by the central rotatable shaft 3115.

In some embodiments, tissue cutting system 3100 includes an aspirationcomponent configured to aspirate tissue debris in proximity to thecentral rotatable shaft 3115 of the tissue cutting device 3105. Theaspiration component includes a vacuum source and an aspirator connectedto the vacuum source. In the non-limiting embodiment shown in FIG. 31,tissue cutting system 3100 includes an external vacuum source 3145(e.g., a vacuum pump or a water aspirator) in fluid communicationthrough a flow conduit 3150 (e.g., surgical tubing) with an aspirator3155 attached to tissue cutting device 3105. In an aspect, at least aportion of the aspiration component is incorporated into the tissuecutting device. In some embodiments, the aspirator of the aspirationcomponent includes a suction lumen disposed in and defined by thecentral rotatable shaft of the tissue cutting device, the suction lumenconnected to vacuum source and in fluid communication with one or moreopenings defined by the central rotatable shaft of the tissue cuttingdevice. In an aspect, the one or more openings defined by the centralrotatable shaft of the tissue cutting device are positioned along thelength of the central rotatable shaft of the tissue cutting device. Insome embodiments, the entirety of the aspiration component, i.e., thevacuum source and the aspirator, may be incorporated into the tissuecutting device of the tissue cutting system.

In some embodiments, tissue cutting system 3100 includes an irrigationcomponent configured to irrigate tissue in proximity to the centralrotatable shaft 3115, the irrigation component including a flow conduitattached to an irrigation fluid reservoir. In an aspect, at least aportion of the irrigation component is incorporated into the tissuecutting device 3105. In the non-limiting embodiment shown in FIG. 31,tissue cutting system 3100 includes an external irrigation fluidreservoir 3160 in fluid communication through a flow conduit 3165 (e.g.,surgical tubing) with an irrigation tube 3170 positioned proximal to thecentral rotatable shaft 3115 of the tissue cutting device 3105. In someembodiments, the flow conduit of the irrigation component includes anirrigation lumen disposed in and defined by the central rotatable shaftof the tissue cutting device, the irrigation lumen connected to theirrigation fluid reservoir and in fluid communication with one or moreopenings defined by the central rotatable shaft of the tissue cuttingdevice. In some embodiments, the entirety of the irrigation componentmay be incorporated into the tissue cutting device of the tissue cuttingsystem. In some embodiments, the entirety of the irrigation componentmay be a separate entity from the tissue cutting device. For example,the irrigation tube attached to the irrigation fluid reservoir may bephysically separated from the tissue cutting device and held by a secondhand of a user, e.g., a physician, or a second practitioner, e.g., anurse. The irrigation fluid reservoir 3160 is configured to hold andcontrollably release at least one irrigation fluid. In an aspect, the atleast one irrigation fluid includes at least one of saline, a buffer, atherapeutic agent, an antimicrobial agent, an anesthetic, or a coagulantagent. In an aspect, a tissue cutting system includes an aspirationcomponent and an irrigation component.

In some embodiments, tissue cutting system 3100 includes animage-capture device 3175, the image-capture device operably coupled tothe computing component 3110, computing component 3110 includingcircuitry configured to receive image data from the image-capturedevice. In an aspect, the received image data includes one or moreimages of a tissue in proximity to the central rotatable shaft of thetissue cutting device. For example, the image-capture device can beconfigured to collect images of a target tissue before, during, and/orafter a cutting or resection procedure to monitor progress and successof the procedure. In an aspect, the image-capture device includes anoptical image-capture device. In an aspect, the image-capture deviceincludes an ultrasound image-capture device. In an aspect, at least aportion of the image-capture device is incorporated into tissue cuttingdevice 3105. In the non-limiting embodiment shown in FIG. 31, tissuecutting system 3100 includes image-capture device 3175 incorporated intotissue cutting device 3105. In other embodiments, the image-capturedevice may include an external image-capture device, e.g., a digitalcamera or laparoscope. In an aspect, computing component 3110 includescircuitry configured to control at least one of the motor 3125 and thetethering component 3135 of tissue cutting device 3105 in response tothe received image data.

In some embodiments, tissue cutting system 3100 includes at least oneanalyte sensor. In an aspect, at least a portion of the analyte sensoris incorporated into the tissue cutting device 3105. In the non-limitingembodiment shown in FIG. 31, tissue cutting system 3100 includes atleast a portion of at least one analyte sensor 3180 is incorporated intothe tissue cutting device 3105. In an aspect, the at least one analytesensor may be external to the tissue cutting device. For example, the atleast one analyte sensor may be positioned in or accessible from theflow conduit 3150 leading to the vacuum source 3145 of tissue cuttingsystem 3100. In an aspect, the at least one analyte sensor includes atleast one of an optical sensor, a magnetic sensor, an electrical sensor,an acoustic sensor, or a chemical sensor. In an aspect, the at least oneanalyte sensor is configured to sense a property of one or more analytesin an aspirate. In an aspect, the at least one analyte sensor isconfigured to sense an optical property, a fluorescence property, amagnetic property, an electrical property, an electromagnetic property,an acoustic property, or a chemical property of the one or more analytesin the aspirate. In an aspect, the at least one analyte sensor isoperably coupled to the computing component 3110, the computingcomponent 3110 including circuitry configured to receive sensor inputfrom the at least one analyte sensor and to control at least one of themotor 3125 and the tethering component 3135 in response to the receivedsensor input.

In some embodiments, tissue cutting system 3100 includes a torquecompensation component 3185. In an aspect, the torque compensationcomponent 3185 includes circuitry configured to prevent oscillation. Forexample, the torque compensation component is configured to preventoscillation of the tissue cutting device when performing asymmetriccutting patterns. In an aspect, the torque compensation component oftissue cutting system 3100 includes at least one counterweight. In anaspect, the at least one counterweight is extendable.

In some embodiments, tissue cutting system 3100 includes dragcompensation component 3190. In an aspect, the drag compensationcomponent 3190 includes circuitry configured to measure drag from theelongated flexible cutting component 3130 of tissue cutting device 3105during rotation. The drag compensation component 3190 is operablycoupled to the computing component 3110. The computing component 3110including circuitry configured to control at least one of the motor 3125and the tethering component 3135 in response to the measured drag.

In some embodiments, tissue cutting system 3100 includes a cauterycomponent 3195 to cauterize tissue. For example, tissue cutting system3100 can include a cautery component configured to cauterize tissuebefore, during, and/or after a cutting procedure. In an aspect, thecautery component is operably coupled to the elongated flexible cuttingcomponent 3130. For example, the elongated flexible cutting componentcan be configured to cauterize tissue before, during, and/or after acutting procedure. In an aspect, the cautery component includes anelectrical cautery component. For example, the elongated flexiblecutting component may be configured to heat up upon carrying anelectrical current. In an aspect, the cautery component includes anoptical cautery component. In an aspect, the cautery component includesa thermal cautery component. For example, the elongated flexible cuttingcomponent may be configured to hold heat. In an aspect, the cauterycomponent includes a chemical cautery component. For example, theirrigation fluid reservoir may be configured to hold and controllablyrelease a chemical cauterizing agent. In an aspect, at least a portionof the cautery component is incorporated into the tissue cutting device.

The state of the art has progressed to the point where there is littledistinction left between hardware, software, and/or firmwareimplementations of aspects of systems; the use of hardware, software,and/or firmware is generally (but not always, in that in certaincontexts the choice between hardware and software can becomesignificant) a design choice representing cost vs. efficiency tradeoffs.There are various vehicles by which processes and/or systems and/orother technologies described herein can be effected (e.g., hardware,software, and/or firmware), and that the preferred vehicle will varywith the context in which the processes and/or systems and/or othertechnologies are deployed. For example, if an implementer determinesthat speed and accuracy are paramount, the implementer can opt for amainly hardware and/or firmware vehicle; alternatively, if flexibilityis paramount, the implementer can opt for a mainly softwareimplementation; or, yet again alternatively, the implementer can opt forsome combination of hardware, software, and/or firmware. Hence, thereare several possible vehicles by which the processes and/or devicesand/or other technologies described herein can be effected, none ofwhich is inherently superior to the other in that any vehicle to beutilized is a choice dependent upon the context in which the vehiclewill be deployed and the specific concerns (e.g., speed, flexibility, orpredictability) of the implementer, any of which can vary. Opticalaspects of implementations will typically employ optically-orientedhardware, software, and or firmware.

In some implementations described herein, logic and similarimplementations can include software or other control structures.Electronic circuitry, for example, can have one or more paths ofelectrical current constructed and arranged to implement variousfunctions as described herein. In some implementations, one or moremedia can be configured to bear a device-detectable implementation whensuch media hold or transmit a device detectable instructions operable toperform as described herein. In some variants, for example,implementations can include an update or modification of existingsoftware or firmware, or of gate arrays or programmable hardware, suchas by performing a reception of or a transmission of one or moreinstructions in relation to one or more operations described herein.Alternatively or additionally, in some variants, an implementation caninclude special-purpose hardware, software, firmware components, and/orgeneral-purpose components executing or otherwise invokingspecial-purpose components. Specifications or other implementations canbe transmitted by one or more instances of tangible transmission mediaas described herein, optionally by packet transmission or otherwise bypassing through distributed media at various times.

Alternatively or additionally, implementations can include executing aspecial-purpose instruction sequence or invoking circuitry for enabling,triggering, coordinating, requesting, or otherwise causing one or moreoccurrences of virtually any functional operations described herein. Insome variants, operational or other logical descriptions herein can beexpressed as source code and compiled or otherwise invoked as anexecutable instruction sequence. In some contexts, for example,implementations can be provided, in whole or in part, by source code,such as C++, or other code sequences. In other implementations, sourceor other code implementation, using commercially available and/ortechniques in the art, can be compiled//implemented/translated/converted into a high-level descriptor language(e.g., initially implementing described technologies in C or C++programming language and thereafter converting the programming languageimplementation into a logic-synthesizable language implementation, ahardware description language implementation, a hardware designsimulation implementation, and/or other such similar mode(s) ofexpression). For example, some or all of a logical expression (e.g.,computer programming language implementation) can be manifested as aVerilog-type hardware description (e.g., via Hardware DescriptionLanguage (HDL) and/or Very High Speed Integrated Circuit HardwareDescriptor Language (VHDL)) or other circuitry model which can then beused to create a physical implementation having hardware (e.g., anApplication Specific Integrated Circuit). Those skilled in the art willrecognize how to obtain, configure, and optimize suitable transmissionor computational elements, material supplies, actuators, or otherstructures in light of these teachings.

The foregoing detailed description has set forth various embodiments ofthe devices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, each functionand/or operation within such block diagrams, flowcharts, or examples canbe implemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof. Inone embodiment, several portions of the subject matter described hereincan be implemented via Application Specific Integrated Circuits (ASICs),Field Programmable Gate Arrays (FPGAs), digital signal processors(DSPs), or other integrated formats. However, some aspects of theembodiments disclosed herein, in whole or in part, can be equivalentlyimplemented in integrated circuits, as one or more computer programsrunning on one or more computers (e.g., as one or more programs runningon one or more computer systems), as one or more programs running on oneor more processors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, the mechanisms ofthe subject matter described herein are capable of being distributed asa program product in a variety of forms, and that an illustrativeembodiment of the subject matter described herein applies regardless ofthe particular type of signal bearing medium used to actually carry outthe distribution. Examples of a signal bearing medium include, but arenot limited to, the following: a recordable type medium such as a floppydisk, a hard disk drive, a Compact Disc (CD), a Digital Video Disk(DVD), a digital tape, a computer memory, etc.; and a transmission typemedium such as a digital and/or an analog communication medium (e.g., afiber optic cable, a waveguide, a wired communications link, a wirelesscommunication link (e.g., transmitter, receiver, transmission logic,reception logic, etc.), etc.).

In a general sense, the various embodiments described herein can beimplemented, individually and/or collectively, by various types ofelectro-mechanical systems having a wide range of electrical componentssuch as hardware, software, firmware, and/or virtually any combinationthereof; and a wide range of components that can impart mechanical forceor motion such as rigid bodies, spring or torsional bodies, hydraulics,electro-magnetically actuated devices, and/or virtually any combinationthereof. Consequently, as used herein “electro-mechanical system”includes, but is not limited to, electrical circuitry operably coupledwith a transducer (e.g., an actuator, a motor, a piezoelectric crystal,a Micro Electro Mechanical System (MEMS), etc.), electrical circuitryhaving at least one discrete electrical circuit, electrical circuitryhaving at least one integrated circuit, electrical circuitry having atleast one application specific integrated circuit, electrical circuitryforming a general purpose computing device configured by a computerprogram (e.g., a general purpose computer configured by a computerprogram which at least partially carries out processes and/or devicesdescribed herein, or a microprocessor configured by a computer programwhich at least partially carries out processes and/or devices describedherein), electrical circuitry forming a memory device (e.g., forms ofmemory (e.g., random access, flash, read only, etc.)), electricalcircuitry forming a communications device (e.g., a modem, communicationsswitch, optical-electrical equipment, etc.), and/or any non-electricalanalog thereto, such as optical or other analogs. Examples ofelectro-mechanical systems include but are not limited to a variety ofconsumer electronics systems, medical devices, as well as other systemssuch as motorized transport systems, factory automation systems,security systems, and/or communication/computing systems.Electro-mechanical as used herein is not necessarily limited to a systemthat has both electrical and mechanical actuation except as context candictate otherwise.

In a general sense, the various aspects described herein can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, and/or any combination thereof and can beviewed as being composed of various types of “electrical circuitry.”Consequently, as used herein “electrical circuitry” includes, but is notlimited to, electrical circuitry having at least one discrete electricalcircuit, electrical circuitry having at least one integrated circuit,electrical circuitry having at least one application specific integratedcircuit, electrical circuitry forming a general purpose computing deviceconfigured by a computer program (e.g., a general purpose computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g., forms of memory (e.g., random access, flash, readonly, etc.)), and/or electrical circuitry forming a communicationsdevice (e.g., a modem, communications switch, optical-electricalequipment, etc.). The subject matter described herein can be implementedin an analog or digital fashion or some combination thereof.

At least a portion of the devices and/or processes described herein canbe integrated into an image processing system. A typical imageprocessing system generally includes one or more of a system unithousing, a video display device, memory such as volatile or non-volatilememory, processors such as microprocessors or digital signal processors,computational entities such as operating systems, drivers, applicationsprograms, one or more interaction devices (e.g., a touch pad, a touchscreen, an antenna, etc.), control systems including feedback loops andcontrol motors (e.g., feedback for sensing lens position and/orvelocity; control motors for moving/distorting lenses to give desiredfocuses). An image processing system can be implemented utilizingsuitable commercially available components, such as those typicallyfound in digital still systems and/or digital motion systems.

At least a portion of the devices and/or processes described herein canbe integrated into a data processing system. A data processing systemgenerally includes one or more of a system unit housing, a video displaydevice, memory such as volatile or non-volatile memory, processors suchas microprocessors or digital signal processors, computational entitiessuch as operating systems, drivers, graphical user interfaces, andapplications programs, one or more interaction devices (e.g., a touchpad, a touch screen, an antenna, etc.), and/or control systems includingfeedback loops and control motors (e.g., feedback for sensing positionand/or velocity; control motors for moving and/or adjusting componentsand/or quantities). A data processing system can be implementedutilizing suitable commercially available components, such as thosetypically found in data computing/communication and/or networkcomputing/communication systems.

The herein described components (e.g., operations), devices, objects,and the discussion accompanying them are used as examples for the sakeof conceptual clarity and that various configuration modifications arecontemplated. Consequently, as used herein, the specific examples setforth and the accompanying discussion are intended to be representativeof their more general classes. In general, use of any specific exampleis intended to be representative of its class, and the non-inclusion ofspecific components (e.g., operations), devices, and objects should notbe taken limiting.

The herein described subject matter sometimes illustrates differentcomponents contained within, or connected with, different othercomponents. It is to be understood that such depicted architectures aremerely examples, and that in fact many other architectures can beimplemented which achieve the same functionality. In a conceptual sense,any arrangement of components to achieve the same functionality iseffectively “associated” such that the desired functionality isachieved. Hence, any two components herein combined to achieve aparticular functionality can be seen as “associated with” each othersuch that the desired functionality is achieved, irrespective ofarchitectures or intermedial components. Likewise, any two components soassociated can also be viewed as being “operably connected,” or“operably coupled,” to each other to achieve the desired functionality,and any two components capable of being so associated can also be viewedas being “operably couplable,” to each other to achieve the desiredfunctionality. Specific examples of operably couplable include but arenot limited to physically mateable and/or physically interactingcomponents, and/or wirelessly interactable, and/or wirelesslyinteracting components, and/or logically interacting, and/or logicallyinteractable components.

With respect to the use of substantially any plural and/or singularterms herein, the plural can be translated to the singular and/or fromthe singular to the plural as is appropriate to the context and/orapplication. The various singular/plural permutations are not expresslyset forth herein for sake of clarity.

In some instances, one or more components can be referred to herein as“configured to,” “configured by,” “configurable to,” “operable/operativeto,” “adapted/adaptable,” “able to,” “conformable/conformed to,” etc.Those skilled in the art will recognize that such terms (e.g.“configured to”) can generally encompass active-state components and/orinactive-state components and/or standby-state components, unlesscontext requires otherwise.

While particular aspects of the present subject matter described hereinhave been shown and described, changes and modifications can be madewithout departing from the subject matter described herein and itsbroader aspects and, therefore, the appended claims are to encompasswithin their scope all such changes and modifications as are within thetrue spirit and scope of the subject matter described herein. Terms usedherein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). If a specific number of an introduced claim recitation isintended, such an intent will be explicitly recited in the claim, and inthe absence of such recitation no such intent is present. For example,as an aid to understanding, the following appended claims can containusage of the introductory phrases “at least one” and “one or more” tointroduce claim recitations. However, the use of such phrases should notbe construed to imply that the introduction of a claim recitation by theindefinite articles “a” or “an” limits any particular claim containingsuch introduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations. In addition, evenif a specific number of an introduced claim recitation is explicitlyrecited, such recitation should typically be interpreted to mean atleast the recited number (e.g., the bare recitation of “tworecitations,” without other modifiers, typically means at least tworecitations, or two or more recitations). Furthermore, in thoseinstances where a convention analogous to “at least one of A, B, and C,etc.” is used, in general such a construction is intended in the senseone having skill in the art would understand the convention (e.g., “asystem having at least one of A, B, and C” would include but not belimited to systems that have A alone, B alone, C alone, A and Btogether, A and C together,

B and C together, and/or A, B, and C together, etc.). In those instanceswhere a convention analogous to “at least one of A, B, or C, etc.” isused, in general such a construction is intended in the sense one havingskill in the art would understand the convention (e.g., “a system havingat least one of A, B, or C” would include but not be limited to systemsthat have A alone, B alone, C alone, A and B together, A and C together,B and C together, and/or A, B, and C together, etc.). Typically adisjunctive word and/or phrase presenting two or more alternative terms,whether in the description, claims, or drawings, should be understood tocontemplate the possibilities of including one of the terms, either ofthe terms, or both terms unless context dictates otherwise. For example,the phrase “A or B” will be typically understood to include thepossibilities of “A” or “B” or “A and B.”

All of the above U.S. patents, U.S. patent application publications,U.S. patent applications, foreign patents, foreign patent applicationsand non-patent publications referred to in this specification and/orlisted in any Application Data Sheet, are incorporated herein byreference, to the extent not inconsistent herewith.

While various aspects and embodiments have been disclosed herein, otheraspects and embodiments will be apparent to those skilled in the art.The various aspects and embodiments disclosed herein are for purposes ofillustration and are not intended to be limiting, with the true scopeand spirit being indicated by the following claims.

What is claimed is:
 1. A tissue cutting device comprising: a tetheringcomponent, an elongated flexible cutting component having a first endand a second end, the first end and the second end of the elongatedflexible cutting component secured to the tethering component; at leastone tether having a first end and a second end, the first end of the atleast one tether attached to the elongated flexible cutting component ata position between the first end and the second end of the elongatedflexible cutting component, the second end of the at least one tetheroperably coupled to the tethering component, the tethering componentincluding circuitry configured to at least one of extend and retract theat least one tether; and a motor operably coupled to the tetheringcomponent, the motor including circuitry configured to rotate thetethering component and the secured elongated flexible cuttingcomponent; wherein extension and retraction of the at least one tetherby the tethering component changes a shape formed by the elongatedflexible cutting component.
 2. The device of claim 1, furthercomprising: a computing component operably coupled to at least one ofthe tethering component and the motor.
 3. The device of claim 2, whereinthe computing component includes circuitry configured to control atleast one of extension and retraction of the at least one tether by thetethering component. 4.-6. (canceled)
 7. The device of claim 2, whereinthe computing component includes circuitry configured to controlrotational frequency of the motor.
 8. (canceled)
 9. The device of claim1, wherein the tethering component includes at least one rotatablecomponent, the second end of the at least one tether secured to the atleast one rotatable component, the at least one rotatable componentconfigured to at least one of extend and retract the at least onetether. 10.-14. (canceled)
 15. The device of claim 1, wherein theelongated flexible cutting component includes at least one of a flexiblewire, strand, string, fiber, thread, or ribbon. 16.-19. (canceled) 20.The device of claim 1, further comprising: two or more elongatedflexible cutting components.
 21. The device of claim 20, wherein a firstend and a second end of each of the two or more elongated flexiblecutting components is secured to the tethering component and at leastone of the two or more elongated flexible cutting components is attachedto at least one tether. 22.-26. (canceled)
 27. The device of claim 1,wherein the at least one tether is at least one of a wire, strand,string, fiber, thread, ribbon, or rod. 28.-29. (canceled)
 30. The deviceof claim 1, wherein the at least one tether includes at least one firstend attached to the elongated flexible cutting component and at leastone second end operably coupled to the tethering component.
 31. Thedevice of claim 1, further comprising: an aspiration componentconfigured to aspirate tissue debris in proximity to the elongatedflexible cutting component, the aspiration component including a vacuumsource; and an aspirator connected to the vacuum source.
 32. (canceled)33. The device of claim 1, further including: an irrigation componentconfigured to irrigate tissue in proximity to the elongated flexiblecutting component, the irrigation component including a flow conduitattached to an irrigation fluid reservoir.
 34. (canceled)
 35. The deviceof claim 33, wherein the irrigation fluid reservoir is configured tohold and controllably release at least one irrigation fluid. 36.(canceled)
 37. The device of claim 33, wherein the irrigation componentis configured to wet at least a portion of the elongated flexiblecutting component.
 38. (canceled)
 39. The device of claim 1, furthercomprising: an image-capture device, the image-capture device operablycoupled to a computing component, the computing component includingcircuitry configured to receive image data from the image-capturedevice. 40.-41. (canceled)
 42. The device of claim 1, furthercomprising: at least one analyte sensor.
 43. (canceled)
 44. The deviceof claim 42, wherein the at least one analyte sensor is configured tosense a property of one or more analytes in an aspirate.
 45. (canceled)46. The device of claim 1, further comprising: a drag compensationcomponent.
 47. (canceled)
 48. The device of claim 1, further comprising:a torque compensation component.
 49. (canceled)
 50. The device of claim48, wherein the torque compensation component includes at least onecounterweight.
 51. (canceled)
 52. The device of claim 1, furthercomprising: a cautery component to cauterize tissue.
 53. The device ofclaim 52, wherein the cautery component is operably coupled to theelongated flexible cutting component. 54.-58. (canceled)
 59. A tissuecutting system comprising: a tissue cutting device including a tetheringcomponent, an elongated flexible cutting component having a first endand a second end, the first end and the second end of the elongatedflexible cutting component secured to the tethering component; at leastone tether having a first end and a second end, the first end of the atleast one tether attached to the elongated flexible cutting component ata position between the first end and the second end of the elongatedflexible cutting component, the second end of the at least one tetheroperably coupled to the tethering component, the tethering componentconfigured to at least one of extend and retract the at least onetether; and a motor operably coupled to the tethering component, themotor including circuitry configured to rotate the tethering componentand the secured elongated flexible cutting component; and a computingcomponent operably coupled to the tissue cutting device, the computingcomponent including a processor and circuitry.
 60. The system of claim59, wherein the tethering component includes circuitry configured to atleast one of extend and retract the at least one tether.
 61. The systemof claim 59, wherein the tethering component of the tissue cuttingdevice includes at least one rotatable component, the second end of theat least one tether of the tissue cutting device secured to the at leastone rotatable component, the at least one rotatable component configuredto at least one of extend and retract the at least one tether. 62.(canceled)
 63. The system of claim 59, wherein extension and refractionof the at least one tether by the tethering component changes a shapeformed by the elongated flexible cutting component. 64.-72. (canceled)73. The system of claim 59, wherein the tissue cutting device includestwo or more elongated flexible cutting components. 74.-82. (canceled)83. The system of claim 59, wherein the at least one tether of thetissue cutting device includes at least one first end attached to theelongated flexible cutting component and at least one second endoperably coupled to the tethering component.
 84. (canceled)
 85. Thesystem of claim 59, wherein the computing component includes circuitryconfigured to control at least one of extension and retraction of the atleast one tether by the tethering component. 86.-87. (canceled)
 88. Thesystem of claim 59, wherein the computing component includes circuitryconfigured to control the motor.
 89. (canceled)
 90. The system of claim59, wherein the computing component includes circuitry configured tocontrol at least one of extension and retraction of the at least onetether by the tethering component and the rotational frequency of themotor operably coupled to the tethering component to generate a cuttingpattern. 91.-92. (canceled)
 93. The system of claim 59, furthercomprising: an aspiration component configured to aspirate tissue debrisin proximity to the elongated flexible cutting component, the aspirationcomponent including a vacuum source; and an aspirator connected to thevacuum source. 94.-95. (canceled)
 96. The system of claim 59, furtherincluding: an irrigation component configured to irrigate tissue inproximity to the elongated flexible cutting component, the irrigationcomponent including a flow conduit attached to an irrigation fluidreservoir. 97.-102. (canceled)
 103. The system of claim 59, furthercomprising: an image-capture device, the image-capture device operablycoupled to the computing component, the computing component includingcircuitry configured to receive image data from the image-capturedevice. 104.-106. (canceled)
 107. The system of claim 103, wherein thecomputing component includes circuitry configured to control at leastone of the tethering component and the motor of the tissue cuttingdevice in response to the received image data.
 108. (canceled)
 109. Thesystem of claim 59, further comprising: at least one analyte sensor.110.-111. (canceled)
 112. The system of claim 109, wherein the at leastone analyte sensor is configured to sense a property of one or moreanalytes in an aspirate.
 113. (canceled)
 114. The system of claim 109,wherein the at least one analyte sensor is operably coupled to thecomputing component, the computing component including circuitryconfigured to receive sensor input from the at least one analyte sensorand to control at least one of the tethering component and the motor ofthe tissue cutting device in response to the received sensor input. 115.The system of claim 59, further comprising: a drag compensationcomponent.
 116. The system of claim 115, wherein the drag compensationcomponent includes circuitry configured to measure drag from theelongated flexible cutting component during rotation, the dragcompensation component operably coupled to the computing component, thecomputing component including circuitry configured to control at leastone of the tethering component and the motor of the tissue cuttingdevice in response to the measured drag.
 117. The system of claim 59,further comprising: a torque compensation component.
 118. The system ofclaim 117, wherein the torque compensation component includes circuitryconfigured to prevent oscillation. 119.-120. (canceled)
 121. The systemof claim 59, further comprising: a cautery component to cauterizetissue. 122.-124. (canceled)